# Exercise as it relates to Disease/Resistance training and how it affects the pain and function among adults with osteoarthritis
## What is the background of this research?

It is estimated that 80% of all adults at or over the age of 65 years exhibit radiographic evidence of osteoarthritis (OA). Pain in the knee, affected by OA, is the most common symptom of the disease and contributes to significant declines in functionality which includes ascending and descending stairs as well as getting up off the floor. Investigators had found that resistance training can reverse the decline of strength within older adults, but they had also found that exercise interventions such as resistance training could in fact slow or reverse the negative outcomes of OA.

## Where is the research from?

The research contained 102 community-dwelling individuals. 74 women and 28 men that had been previously diagnosed with knee OA. The individuals were chosen if they reported a moderate degree of knee pain as evidenced by a 5 or greater on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. R. Topp is a professor from the university of San Diego that has extensive knowledge is osteoarthritis of the knee and how it affects several individuals. He has also investigated several techniques used to minimise the injuries accompanied by the disease as well as the possibility to reverse the affects. The study was conducted from the School of Nursing, Medical College of Georgia, Schools of Allied Health and Medicine and the Medical College of Ohio. The authors that conducted the study include Robert Topp, Sandra Woolley, Joseph Hornyak III, Sadik Khuder, and Bashar Kahaleh.

## What kind of research was this?

This research study is a randomised-control trial, as the population gained a baseline at the beginning of the 16 weeks. Then following this, the population was split into a dynamic exercise group, an isometric exercise group and then a control group. Results were then compared again at the end of the 16 weeks.

## What did the research involve?

One hundred and two men (28) and women (74) previously diagnosed with knee OA volunteered and participated in the present study. During an initial telephone interview, they reported a moderate degree of knee pain, caused by the OA and was scored by a 5 or greater on the WOMAC pain subscale. Potential subjects excluded if there were contradictions for exercise. If they made it passed the telephone interview, then a background and demographic questionnaire took place and underwent a history and physical examination. Subjects who were eligible were placed into 3 categories of assessments before being randomized into treatment groups. The participants would then complete these assessments after 16 weeks of participation in their respective groups. The first assessment included the subject reporting background information on demographics and use of medications to manage their knee pain. The second assessment included paper and pencil instruments that solicited the subject’s perceived knee pain, stiffness and functional ability. The final assessment assessed pain and functional ability while each subject performed 4 functional tasks. These tasks included getting down to and up off the floor and then ascending and descending stairs. Limitations include the use of self-report throughout the study. It is quite well known that self-reported or subjective data can impact the validity of a study. What reduces the room for error within these tests and increases the validity and reliability is the fact that the 4 functionality tests are timed. This increases the objectivity of the testing and less biasness as well. As these tests were conducted both at the beginning and end of a 16-week period, there were results to compare with.

## What were the basic results?

From the beginning to the end of the study, there was a nonsignificant decrease in medication dosage. Both resistance-training groups exhibited similar significant declines in knee pain and in time to perform functional tasks while the control group remained unchanged over the duration of the study. For the dynamic group, the score dropped from 5.51 mean to 5.04 mean. The Isometric group dropped from 5.13 to 5.03. The scores did drop but not very significantly. The time to get down to the floor dropped from 4.72 seconds to 3.89 seconds for the dynamic group and then 5.56 seconds to 4.31 seconds for the isometric group. The time to get up off the floor also dropped from 7.16 seconds to 5.71 seconds for the dynamic group and 8.26 seconds to 6.37 seconds for the isometric group. The time to go upstairs decreased as well. For the dynamic group, the time decreased from 18.85 seconds down to 16.33 seconds and the isometric group dropped from 17.99 seconds down to 15.15 seconds. The time to go down the stairs dropped from 19.29 seconds to 15.96 seconds for the dynamic group and 16.86 seconds to 13.95 seconds for the isometric group.

## What conclusions can we take from this research?

Both dynamic and isometric resistance training reduced perceived knee joint pain and had no effect on perceived joint stiffness. Only dynamic training reduced perceived functional limitations. The control group had no change in measures throughout the entire study. The results from the present study seem to support the efficacy of prescribing various resistance-training programs as a method to enhance their functional ability and to reduce their knee joint pain. The conclusion I have come to from the study is slightly different. Even though there seems to be a pattern that knee joint pain and functionality has improved, it still has the biasness caused by the individual’s interpretations which can change from person to person. This means it is quite hard to determine the reliability and validity of the tests being produced. In saying that, by using the times to compare between the start and end of the 16-week intervention period, the validity does increase quite significantly. I believe that a longer study period should be used to determine whether the testing has any long term, positive or negative effects on individuals that are being tested. Hopefully from a longer study period, more of a pattern I’ll be produced that will show a stronger correlation of time decreasing in the 4 functionality tests that challenge the individuals.

## Practical advice

This study is very useful for individuals in similar situations as well as health practitioners and researchers that are interested in this area of study. For those individuals that struggle with OA in the knee or other areas of their body, it is a good interpretation of ways and exercises that are needed to reduce and possibly reverse the effects of OA. Performing some form of resistance training has been shown to improve the functionality of the knee joint and can decrease pain within the joint. Researchers can take the next step and identify whether specific resistance training affects different parts of the body. By continuing with controlled clinical trial testing, it helps determine whether the controls improve over time and/or whether the intervention groups improve and if so, by how much. It is important that the use of time is continued on top of subjective questioning as it allows other researchers to compare results much easier than having to interpret subjective results.

## Further information/Resources

Osteoarthritis.<ref> Osteoarthritis.<ref>

## References

Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review of randomized clinical trials.<ref> Quantitative Effects of Physical Therapy on Muscular and Functional Performance in Subjects With Osteoarthritis of the Knees.<ref> The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee.<ref> PREDICTING FUNCTIONAL TASKS PERFORMANCE AMONG OLDER ADULTS FROM STRENGTH AND JOINT PAIN 34.<ref> Self-Efficacy and Pain in Disability with Osteoarthritis of the Knee.<ref> A Randomized Trial Comparing Aerobic Exercise and Resistance Exercise With a Health Education Program in Older Adults With Knee Osteoarthritis.<ref>