# Exercise as it relates to Disease/The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis

This is an information fact sheet and analysis of the article "The Effects of Aquatic and Traditional Exercise Programs on Persons With Knee Osteoarthritis," a clinical trial by Wyatt et al (2001).

## Osteoarthritis

Osteoarthritis (OA) is the progressive degeneration of a joints articular cartilage, causing the cartilage that covers the ends of bones to become painfully worn away, with the resulting condition termed osteoarthritis. With 80% of people over the age of 45 having OA of at least 1 joint, it is the most common joint disorder.It is widely excepted that exercise is a beneficial treatment for knee OA, however there is no clear opinion on the use of aquatic exercise. This article aims to explore the effects of aquatic based exercises and to also compare them to traditional land based exercises in the treatment of knee OA.

## Where is the research from?

This study was conducted by the following universities:
* Baylor University, Texas - Department of Health, Human Performance, and Recreation.
* Western Kentucky University, Kentucky - Department of Physical Education and Recreation.
* Wichita State University, Kansas - Department of Kinesiology and Sport Studies.

## What kind of research was this?

This study was clinical trial conducted over a period of 6 weeks,allowing the researchers to examine the validity of aquatic based exercises and to also compare them to that of traditional and proven land based activity.

## What did the research involve?

46 men and women met the inclusion criteria and were randomly placed into either the land based or aquatic exercise groups. Both groups completed the same exercises 3 times per week for 6 weeks and were advised to otherwise only complete their regular activity.
Inclusion Criteria:
* Aged 45-70.
* Diagnosed with moderate OA of the knee without other lower limb condition.
Exclusion Criteria:
* Inflammatory joint disease.
* Significant OA in other joints, likely to affect ability to exercise.
* Any neurological, respiratory or cardiovascular disease.
Baseline and post treatment testing:
| Test | Rationale |
| Knee range of motion (ROM) | To assess the amount of movement of the effected knee |
| Thigh girth measurement | A measurement of muscle mass involved in knee movement |
| Visual analogue pain scale | A patients own measurement of their pain |
| Timed 1 mile walk | A measurement of functional capacity |
Exercises:
* Knee extension and flexion.
* 4-way straight leg raises.
* Mini-squats.
* Walking 800 feet.

## What were the basic results?

Both the land and aquatic exercise groups showed clinically significant differences between pre and post treatment testing, with knee ROM and thigh girth increasing whilst pain scale scores and 1 mile walk times decreased. There was no significant difference between the 2 exercise groups for knee ROM, thigh girth or 1 mile walk times, however there was a significantly lower pain scale scores for the aquatic exercise group compared to the land exercise group.
Land Exercise Group:
| Test | Pre | Post |
| Knee ROM (degrees) | 108.9 | 120.8 |
| Thigh Girth (inches) | 19.4 | 19.5 |
| Pain Scale (0-10) | 5.6 | 3.8 |
| 1 Mile Walk (min) | 21.9 | 19.7 |
Aquatic Exercise Group:
| Test | Pre | Post |
| Knee ROM (degrees) | 100.9 | 117.3 |
| Thigh Girth (inches) | 18.8 | 19 |
| Pain Scale (0-10) | 4.5 | 2.4 |
| 1 Mile Walk (min) | 20.8 | 18.9 |

## What conclusions can we take from this research?

This study aimed to explore the effectiveness of aquatic based exercise for knee OA and also to compare its effect to that of land based exercise programs. Despite their being no clinical significant differences in the results for knee ROM, thigh girth or 1 mile walk tests, there was noted difference between the 2 groups for pain scale scores.Aqautic environments aid people with musculoskeletal conditions to exercise, whilst the buoyancy of water decreases the load placed on joints, which leads to a decrease in pain scores.

## Practical advice

* Exercise programs consisting of 3 sessions per week, help to maintain and increase function in people with knee OA.
* Exercise serves to increase knee ROM whilst decreasing muscle atrophy and levels of pain.
* Due to the lack of clinical significance between the 2 exercise groups, patients are best served with a combination approach when treating knee OA. Comprised of both exercise (land and aquatic) and therapeutic intervention.

## Further readings & information

* The Basic Science of Articular Cartilage: Structure, Composition, and Function: http://journals.sagepub.com/doi/abs/10.1177/1941738109350438
* Osteoarthritis Fact Sheet: https://www.niams.nih.gov/health_info/osteoarthritis/osteoarthritis_ff.asp
* Tips for Osteoarthritis of the Hip and Knee: http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2015/Areas%20of%20body/Tipsforosteoarthritishipknee.pdf

## References

* 1 2 3 4 5 6 7 8 WYATT F, MILAM S, MANSKE R, DEERE R. The Effects of Aquatic and Traditional Exercise Programs on Persons With Knee Osteoarthritis. The Journal of Strength and Conditioning Research. 2001;15(3):337.
* ↑ Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. New England Journal of Medicine. 1991 Jul 11;325(2):87-91.
* ↑ Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Annals of the rheumatic diseases. 2003 Dec 1;62(12):1145-55.
* ↑ Everix, D. Aquatics and arthritis. Advanced Rehabilitation. 1995: 63-66.
* ↑ Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and cartilage. 2008 Feb 29;16(2):137-62.