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Knee Osteoarthritis and the Efficacy of Kinesthesia, Balance & Agility Exercise Training: A Pilot Study.

ABSTRACT: Kinesthesia, balance and agility (KBA) neuromuscular exercises are commonly used for rehabilitation of lower extremity injuries. KBA combined with strength training (ST) reportedly improves function among persons with knee osteoarthritis (OA), but independent effects of KBA are unknown. The purpose of this study was to determine the efficacy of KBA exercises, independent of ST, to improve function among persons with knee OA. Twenty participants (69.3, SD 11.4 y) were randomized to 8 weeks, 3-days per week, instructor-lead KBA or ST groups. Self-reported physical function (difficulty with daily living activities such as walking, bending, stair climbing, etc.) was measured at baseline and every two weeks. Community physical activity level, negative and positive outcome expectancies for exercise, self-reported knee stability, and timed 10-stair climb, 10-stair descent, and 'get up and go' 15 m walk were measured at baseline and follow-up. Physical function improved 59% (p = 0.02) with KBA and 40% (p = 0.02) with ST at 8 weeks. Community physical activity level improved only in KBA (p = 0.04); knee stability improved in both KBA (p = 0.04) and ST (p = 0.01). There were no significant between-group differences (p > 0.05). In conclusion, both interventions appear to improve function and knee stability among persons with symptomatic knee OA. As KBA has never been studied as an independent treatment program, our results indicate it is a promising stand-alone intervention worthy of further study.

SUBMITTER: Rogers MW

PROVIDER: S-EPMC4738996 | biostudies-literature | 2011

REPOSITORIES: biostudies-literature

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Knee Osteoarthritis and the Efficacy of Kinesthesia, Balance & Agility Exercise Training: A Pilot Study.

Rogers Matthew W MW Tamulevicius Nauris N Coetsee Marius F MF Curry Beth F BF Semple Stuart J SJ

International journal of exercise science 20110415 2

Kinesthesia, balance and agility (KBA) neuromuscular exercises are commonly used for rehabilitation of lower extremity injuries. KBA combined with strength training (ST) reportedly improves function among persons with knee osteoarthritis (OA), but independent effects of KBA are unknown. The purpose of this study was to determine the efficacy of KBA exercises, independent of ST, to improve function among persons with knee OA. Twenty participants (69.3, SD 11.4 y) were randomized to 8 weeks, 3-day ...[more]

PMID: 27182359

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Project description:The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ? 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05) improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid-point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach for persons with knee OA.

Project description:BackgroundKnee osteoarthritis (OA) is a common painful and disabling condition that affects older individuals. Proprioceptive training programs in the form of kinesthesia, balance and agility (KBA) exercises have been reported to be beneficial for individuals with knee OA. However, the most optimal training dosage of KBA exercises is still unclear. The aim of this study is to determine the effects of different frequencies of KBA training (i.e., twice-weekly or thrice-weekly) in adults with knee OA.MethodsA single (assessor) blind, three-arm parallel, multi-center randomized controlled trial will be conducted. One hundred twenty adults with knee OA will be recruited from four tertiary hospitals in Northwestern Nigeria and randomly assigned into one of three intervention groups; twice-weekly KBA (n = 40), thrice-weekly KBA (n = 40), and conventional physiotherapy (n = 40) in the ratio of 1:1:1. Participants in the conventional physiotherapy group will receive two sessions of brief patient education, and sixteen sessions of ultrasound therapy, and stretching and strengthening exercises for 8 weeks. Participants in the two different KBA groups will receive KBA training according to the designed sessions for 8 weeks in addition to the conventional physiotherapy program. All groups will be assessed pre-intervention, immediately post-intervention and at 3 months, 4 months, and 6 months post-randomization. The primary outcome will be physical function (Ibadan Knee and Hip Osteoarthritis Outcome Measure) whereas the secondary outcomes will be pain intensity (Visual Analogue Scale for pain), knee stability (Knee Outcome Survey-Activities of Daily Living Scale), proprioception (electronic goniometer), and quality of life (Osteoarthritis Knee and Hip Quality of Life Questionnaire).DiscussionThe findings of this study may provide evidence on the effectiveness of KBA exercise training and the ideal number of sessions needed to achieve the highest effectiveness in adults with knee OA.Trial registrationPan African Clinical Trials Registry ( PACTR201810713260138 ). Registered on 28 November 2017.

Project description:BackgroundIn addition to generally high levels of physical activity, multi-component exercise training is recommended for the maintenance of health and fitness in older adults, including the prevention of falls and frailty. This training often encompasses serial sequencing of balance, strength, endurance and other types of exercise. Exercise training featuring integrative training of these components (i.e. agility training) has been proposed, as it more likely reflects real life challenges like stop-and-go patterns, cutting manoeuvers, turns and decision-making. In this study, we compared the efficacy of an agility-based training to the traditional strength and balance training approach with regard to selected risk factors for falls and frailty.MethodsWe trained twenty-seven community-dwelling healthy seniors (16♂; 11♀; age: 69.5 ± 5.3 y; BMI: 26.4 ± 3.7 kg/m2) for 8 weeks in a group setting with 3 sessions per week, each lasting 50 minutes. Participants were randomized into either the agility group (AGI; n = 12), that used the integrative multi-component training, or the traditional strength and balance group (TSB; n = 15). TSB performed balance and strength exercises separately, albeit within the same session. The training of both groups progressively increased in difficulty. Outcomes were static and dynamic balance (single leg eyes open stand, Y-balance test, reactive balance), lower limb (plantar flexion and dorsal extension) and trunk flexion and extension maximum strength and rate of torque development (RTD). In addition, we tested endurance by the six-minute walk test (6MWT). We calculated linear mixed effects models for between-groups comparisons as well as effect sizes (ES) with 95 % confidence intervals.ResultsSmall ES in favor of AGI were found for plantar flexion strength (ES > 0.18[-0.27;0.89]) and RTD (ES > 0.43[-0.19;1.36]) as well as trunk extension RTD (ES = 0.35[-0.05;0.75]). No other parameters showed notable between group differences. Compliance was high in both groups (AGI: 90 ± 8% of sessions; TSB: 91 ± 7% of sessions).DiscussionAgility-based exercise training seems at least as efficacious as traditional strength and balance training in affecting selected physical performance indicators among community-dwelling healthy seniors. In particular, lower limb and trunk extension explosive strength seem to benefit from the agility training.

Project description:The number of falls experienced by people with knee osteoarthritis (OA) is almost double the number experienced by people with no OA. The neuromuscular elements required to arrest a fall are more impaired in people with knee OA compared to their asymptomatic counterparts. Therefore, these elements may need to be incorporated into an exercise intervention to reduce the risk of falling. The aim of this study will be to examine the feasibility, safety and patient satisfaction of a high-speed resistance-training program, with and without balance exercises, in people with knee OA compared to a control group. The effect of these exercise programs on lower-limb muscle strength and physiological and functional risk factors for falls will also be examined.This study will be a pilot randomized controlled trial with a pre- and post-intervention design (outcome assessments at baseline and 8 weeks after participation commencement) comparing three groups: a control group (no intervention), a high-speed resistance-training group and a high-speed resistance-training plus balance exercises group. Thirty people with knee osteoarthritis aged 60-90 years will be recruited and randomized to one of the three groups. Feasibility and safety will be assessed by examining adherence to the exercise program, dropout rate, pain level during and following exercise, number of exercises stopped due to pain, and any adverse event or any incident that prevents the participant from completing the prescribed exercise. Secondary measures of lower-limb strength, physical function, self-reported pain and function, fear of falls, and executive function and quality of life will also be assessed. To determine statistical trends of effectiveness and hence to inform sample size for a fully powered study, analyses of the secondary outcomes will be performed to assess the changes within and between groups over time (pre-post) using repeated measure ANOVA.The results of this study will improve understanding of what type of exercise is safe and beneficial for people with knee OA to reduce their risk of falling, and hence will inform the development of a future large research trial.Australian New Zealand Clinical Trials Registry, ID: ACTRN12616001382460 . Registered on 6 October 2016.

Project description:Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis (OA). It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function.The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to standard exercise therapy compared with the standard exercise program alone for people with knee OA.This was a single-blinded randomized controlled trial.The study was conducted in the outpatient physical therapy clinic of a large, university-based health center.One hundred eighty-three people with knee OA (122 women, 61 men) participated.Participants were randomly assigned to either a group that received agility and perturbation training with standard exercise therapy or a group that received only the standard exercise program.The outcome measures were self-reported knee pain and function, self-reported knee instability, a performance-based measure of function, and global rating of change.Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2-, 6-, and 12-month follow-up periods, there were no differences between groups on these outcomes. There was no reduction in knee pain or improvement in performance-based function in either group.It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach.Both intervention groups exhibited improvement in self-reported function and the global rating of change. Our results, however, did not support an additive effect of agility and perturbation training with standard exercise therapy in our sample of individuals with knee OA. Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach.

Project description:Little is known about the relationships of circulating levels of biomarkers of cartilage degradation with biomechanical outcomes relevant to knee osteoarthritis (OA) or biomarker changes following non-pharmacological interventions. The objectives of this exploratory, pilot study were to: 1) examine relationships between biomarkers of articular cartilage degradation and synthesis with measures of knee joint load during walking, and 2) examine changes in these biomarkers following 10 weeks of strengthening exercises.Seventeen (8 male, 9 female; 66.1 +/- 11.3 years of age) individuals with radiographically-confirmed medial tibiofemoral OA participated. All participants underwent a baseline testing session where serum and urine samples were collected, followed by a three-dimensional motion analysis. Motion analysis was used to calculate the external knee adduction moment (KAM) peak value and impulse. Following baseline testing, participants were randomized to either 10 weeks of: 1) physiotherapist-supervised lower limb muscle strengthening exercises, or 2) no exercises (control). Identical follow-up testing was conducted 11 weeks after baseline. Biomarkers included: urinary C-telopeptide of type II collagen (uCTX-II) and type II collagen cleavage neoepitope (uC2C), serum cartilage oligomeric matrix protein (sCOMP), serum hyaluronic acid (sHA) and serum C-propeptide of type II procollagen (sCPII). Linear regression analysis was used to examine relationships between measures of the KAM and biomarker concentrations as baseline, as well as between-group differences following the intervention.KAM impulse predicted significant variation in uCTX-II levels at baseline (p?=?0.04), though not when controlling for disease severity and walking speed (p?=?0.33). KAM impulse explained significant variation in the ratio uCTX-II;sCPII even when controlling for additional variables (p?=?0.04). Following the intervention, changes in sCOMP were significantly greater in the exercise group compared to controls (p?=?0.04). On average those in the control group experienced a slight increase in sCOMP and uCTX-II, while those in the exercise group experienced a reduction. No other significant findings were observed.This research provides initial evidence of a potential relationship between uCTX-II and knee joint load measures in patients with medial tibiofemoral knee OA. However, this relationship became non-significant after controlling for disease severity and walking speed, suggesting further research is necessary. It also appears that sCOMP is amenable to change following a strengthening intervention, suggesting a potential beneficial role of exercise on cartilage structure.Clinicaltrials.gov NCT01241812.

Dataset Information

Knee Osteoarthritis and the Efficacy of Kinesthesia, Balance & Agility Exercise Training: A Pilot Study.

Publications

Knee Osteoarthritis and the Efficacy of Kinesthesia, Balance & Agility Exercise Training: A Pilot Study.

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