JOURNAL OF SPORTS SCIENCE & MEDICINE
EFFICACY OF HOME-BASED KINESTHESIA, BALANCE & AGILITY EXERCISE TRAINING AMONG PERSONS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS
Matthew W. Rogers1, Nauris Tamulevicius2, Stuart J. Semple1 and Zarko Krkeljas3
1Department of Biokinetics & Sport Science, University of Zululand, KwaDlangezwa, South Africa; 2School of Human Performance and Leisure Sciences, Barry University, Miami Shores, USA; 3School for Biokinetics, Recreation and Sport Science, North-West University, Potchefstroom, South Africa
© Journal of Sports Science and Medicine (2012) 11, 751 - 758
|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
Key words: Exercise therapy, rehabilitation, postural balance, resistance training.
It has been estimated that over 27 million persons in the United
States have osteoarthritis (OA) in one or more joints (Lawrence et al.,
Symptomatic knee OA alone affects 12% of American adults, making it one
of the most frequent causes of physical disability and pain among older
persons (Dillon et al., 2006).
Indeed, nearly half of all Americans will develop symptomatic knee OA
by age 85 (Murphy et al., 2008).
Such persons often report difficulty with daily activities such as walking,
climbing stairs, stooping, and standing up from a seated position due
to knee pain, weakness or instability (Dillon et al., 2006).
The Osteoarthritis Research Society International (OARSI) recommendations
for hip and knee OA management (Zhang et al., 2007;
note a number of interventions have been universally recommended by the
published treatment guidelines, though the efficacy of many of these treatments
(e.g., massage, ultrasound, heat/ice therapy) has not been confirmed.
However, OARSI reports there is a growing body of evidence for the efficacy
of exercise interventions for treating knee OA symptoms (Zhang et al.,
A number of therapeutic exercise programs have been reported to be effective
in this regard (e.g., Bennell and Hindman, 2005;
Bennell et al., 2010;
Diracoglu et al., 2005;
Fitzgerald et al., 2002;
Hicks et al., 2001;
Lange et al., 2008;
Mikesky et al., 2006;
Sekir and Gur, 2005).
A variety of isotonic, isometric, and isokinetic lower extremity resistance
training programs have been commonly employed in intervention programs,
given the recognition of a nearly universal presence of quadriceps femoris
muscle weakness among persons with knee OA (Bennell and Hindman, 2005;
Mikesky et al., 2006).
A single-blind, block randomized placebo controlled clinical trial with four interventions was conducted between February 2009 and July 2011. The study was approved by the Ethics Committee of the Faculty of Science and Agriculture of The University of Zululand and registered at Clinicaltrials.gov (NCT00735098). A dynamic entry cohort was utilized wherein participants began the study as soon as they were qualified and ready to start. Written informed consent was obtained from each participant before testing began.
the conclusion of each exercise session, participants in all three programs
completed one set of 30-second static stretches of the calves, quadriceps,
baseline characteristics are presented in Table
4. Thirty-three participants (20 women, 13 men) completed the 8 week
trial (KBA, n = 8; RT, n = 8; KBA+RT, n = 9, and Control, n = 8). Three
participants in each group had been diagnosed with unilateral knee OA,
and the remainder with bilateral knee OA. Reasons for loss to follow up
include: injury/illness unrelated to study (n = 4); no-show for follow-up
testing (n = 1); joined an exercise program (n = 1); caring for ill family
member (n = 1); out of state emergency (n = 1); and other rheumatic disease
diagnosed during study (n = 1). In addition, two participants cited increased
knee pain as their reason to discontinue the study. One of these participants
was in the KBA condition and greatly exceeded the exercise prescription,
logging 90 steps per exercise in the first two weeks. The other participant
was in the RT intervention and completed only one session. This participant
considered having been on her feet for 6 hours the day before her first
session to be responsible for the pain flair up. Compliance with the interventions
among program completers is as follows (mean and standard deviation):
KBA 95.3 (6.5)%; RT 96.4 (8.8)%; KBA+RT 98.6 (2.95)%; and Control 97.0
(5.5)%. There were no changes in the usage of pain medication.
three home-based exercise programs appeared to be relatively equal in
their ability to reduce the symptoms of knee OA, based on the WOMAC Index.
This study is among the first to provide evidence that KBA as a sole intervention
can be effective for this purpose. While this is an encouraging finding,
the research hypothesis regarding greater efficacy with KBA must be rejected.
|Our results indicate that KBA, RT, or a combination of the two administered as home exercise programs appear effective in reducing symptoms and improving the quality of life among persons with knee OA. However, given the limited statistical power and the initial benefit seen with a placebo treatment, these findings must be interpreted with caution. The current evidence suggests clinicians should continue to prescribe RT as part of the rehabilitation program, but further research on the effects of KBA is warranted. Patient presentation and preferences, costs, and convenience remain important factors in choosing an exercise rehabilitation approach for patients with symptomatic knee OA.|
|The authors thank Frances Vaughn, PhD and the late Marius F. Coetsee, PhD for their assistance with the original study design, and Patricia A. Grant and Claudia B. Pratesi for their assistance with manuscript preparation. This research was supported by a product grant from The Thera-Band® Academy, which provided elastic resistance bands and stability trainers.|
Matthew W. ROGERS
EmploymentDoctoral Student, Department of Biokinetics & Sport Science, University of Zululand, South Africa
Research interestsOsteoarthritis rehabilitation.
EmploymentAssistant Professor, School of Human Performance and Leisure Sciences, Barry University, USA
Research interestsApplied Exercise Physiology; Optimization of Physical Conditioning for High Performance Athletes, Occupational Groups and Clinical Population.
Stuart J. SEMPLE
EmploymentAssociate Professor in the Department of Biokinetics and Sports Science at the University of Zululand, South Africa
Research interestsClinical Exercise Physiology
EmploymentDoctoral Student, School for Biokinetics, Recreation and Sport Science, North-West University, South Africa
Research interestsLongitudinal effect of pregnancy on gait parameters, and will offer additional insights into little explored areas of coordination and energetics during pregnancy.