# Exercise as it relates to Disease/Land or water exercise for arthritis sufferers?

This is a clinical study of whether aquatic or land exercise improves knee osteoarthritis. Paper: Wang, T., Lee, S., Liang, S., Tung, H., Wu, S. V., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land‐based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20(17‐18), 2609-2622.
Student ID: 3115151
Osteoarthritis is a degenerative disorder that affects people of all ages. This disease is caused by a number of factors, genetics, constant “wear and tear” and age. It is a prevalent musculoskeletal disorder that still has no particular cure but research aims to develop an effective management plan to improve the sufferers quality of life. Osteoarthritis is the most predominant rheumatic disease which causes constant pain, loss of function and a lack of life¹. Along with physical disability this disease largely distresses health care institutes and results in large costs to society. Managing OA is the key treatment as there is no specific cure, it needs to be tailored individually. The management of OA should be tailored for each patient and treatment guidelines should be taken into consideration.This study was done to assess whether aquatic or land based exercise would improve or increase a better quality of life for knee osteoarthritis sufferers.

#### Where is the research from?

The study was done in Taiwan from people in local community centres and sport centres all suffering knee OA. Most of the studies underwent previously were in a 6-8 week period focused on both hips and knees whereas this study conducted by T-J Wang was over a 12 week block solely focusing on knees.

## What kind of research was this?

This was a critic comparing the difference between aquatic and land based activity for Knee osteoarthritis sufferers. The research was a randomised trial including a local community. The local community involved had specific participants who were chosen because they fit a specific criteria for the study.

#### What Research was done?

There were 84 participants with knee Osteoarthritis who got assigned to either aquatic, land or a controlled group who did not exercise. Exercise for both land and aquatic groups ran for 60 minutes, three times a week for 12 weeks whilst the control group remained without exercise. The research involved a specific criteria to improve the accuracy of the study i.e. age over 55 years, diagnosed Osteoarthritis from physician and X-ray and consent forms completed. The program also excluded specific participants who had other threatening conditions if involved in exercise, received corticosteroid injections in the past 30 days, received a joint replacement or exercise more than 60 mins per week in the last two months. There were a number instruments involved to assess the research this included a knee injury and OA outcome score, a standard plastic goniometer, a six minute walk test and a generalised estimation equation assessing changes over time.

#### What were the Basic Results?

The control group was used to compare the effectiveness of the chosen exercises for both aquatic and land exercise. The basic results revealed that the aquatic group had dramatically lower problems with pain by week 12 and there was a reduction for the land based activity comparing to the control group. Therefore, for the two groups exercising a gradual decline in pain was evident, whereas the control pain remained the same throughout the whole 12 weeks.

## How did the researchers interpret the results?

The researchers presented their results in tables after analysing any results they received. They presented their scores with mean numbers due to the study being randomized in regards to participants involved. Firstly, it was key to note the mean scores towards the investigation presented in a table, this included;
* Demographics
* BMI
* Disease variables.
The key research results are also presented in a table this compared the different environments clearly and concisely. These data presented the results directly related to each hypothesis, they included;
* Pain
* Symptoms
* ADL (Active Daily Living)
* Sport/recreation
* QOL (Quality of Life)
* ROM (Knee Extension & Flexion)
* 6 minute walking test
Also, a comparison table was presented to reveal the differences in each program in respects to what changed, improved, failed and etc.
This was an effective interpretation as the results were clear and concise direct to the point.

## What conclusions should be taken away from this research?

Both the programs based on land and in an aquatic environment revealed to improve pain, support knee range of motion, the ability to stand the generalised 6 minute walk test and improve knee quality of life. Knee osteoarthritis still has no definitive cure but throughout this research it revealed that it can be improved and managed.
There was no ultimate conclusion as to which environment would improve/help with knee osteoarthritis however consideration could be assumed that combining both programs may further improve quality of life.

## What are the implications of this research?

Both environments presented favourable outcomes to the participants in some way or another. Water-based exercises are an effective and appropriate alternative for the maintenance and management of knee osteoarthritis. Although, there still was no specified result it is evident that arthritis sufferers are all different therefore both environments will enhance management. Therefore ideal treatment is to combine both environments and the preference of each specific individual.

## References

* ↑ Wang, T., Lee, S., Liang, S., Tung, H., Wu, S. V., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land‐based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20(17‐18), 2609-2622. doi:10.1111/j.1365-2702.2010.03675.x
* ↑ Wang, T., Lee, S., Liang, S., Tung, H., Wu, S. V., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land‐based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20(17‐18), 2609-2622. doi:10.1111/j.1365-2702.2010.03675.x
* ↑ Valdes, A. M., & Spector, T. D. (2011). Genetic epidemiology of hip and knee osteoarthritis. Nature Reviews.Rheumatology, 7(1), 23.
* ↑ Başaran, S., & Uysal, F. G. (2009). Knee osteoarthritis. Türkiye Fiziksel Tip Ve Rehabilitasyon Dergisi, 55, 1-7.
* ↑ Wang, T., Lee, S., Liang, S., Tung, H., Wu, S. V., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land‐based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20(17‐18), 2609-2622. doi:10.1111/j.1365-2702.2010.03675.x
* ↑ Wang, T., Lee, S., Liang, S., Tung, H., Wu, S. V., & Lin, Y. (2011). Comparing the efficacy of aquatic exercises and land‐based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20(17‐18), 2609-2622. doi:10.1111/j.1365-2702.2010.03675.x
* ↑ Silva, L. E., Valim, V., Ana Paula C Pessanha, Oliveira, L. M., Myamoto, S., Jones, A., & Natour, J. (2008). Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: A randomized clinical trial. Physical Therapy, 88(1), 12-21. doi:10.2522/ptj.20060040