Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Investigation of Clinical Effects of High- and Low-Resistance Training for Patients With Knee Osteoarthritis: A Randomized Controlled Trial Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial Improved Function and Reduced Pain after Swimming and Cycling Training in Patients with Osteoarthritis Land-based versus aquatic resistance therapeutic exercises for older women with sarcopenic obesity: study protocol for a randomised controlled trial High-Intensity Interval Training on an Aquatic Treadmill in Adults With Osteoarthritis: Effect on Pain, Balance, Function, and Mobility Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol The effects of exercise and neuromuscular electrical stimulation in subjects with knee osteoarthritis: a 3-month follow-up study The Effects of a Motorized Aquatic Treadmill Exercise Program on Muscle Strength, Cardiorespiratory Fitness, and Clinical Function in Subacute Stroke Patients: A Randomized Controlled Pilot Trial Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial. Does hydrotherapy improve strength and physical function in patients with osteoarthritis--a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial Comparison of the effects of water- and land-based exercises on the physical function and quality of life in community-dwelling elderly people with history of falling: a single-blind, randomized controlled trial. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial Feasibility and efficacy of an 8-week progressive home-based strengthening exercise program in patients with osteoarthritis of the hip and/or total hip joint replacement: a preliminary trial
Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response BACKGROUND Knee osteoarthritis ( OA ) is a painful condition causing disability and muscle weakness . Shortwave diathermy ( SWD ) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice . However , the efficacy of SWD in knee OA is still inconclusive . AIM The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain , function , muscle strength , quality of life and depression in patients with OA . DESIGN This was a r and omised , controlled clinical trial . SETTING Inpatient Physiotherapy Department . POPULATION Forty women aged between 42 and 74 years , with a diagnosis of bilateral primary knee OA . METHODS Patients were sequentially r and omized into two groups . Group 1 ( N.=20 ) received SWD and isokinetic muscular strengthening exercises . Group 2 ( N.=20 ) served as control group and they received isokinetic exercises only . Both of the programs were performed three days a week , for a duration of four weeks , and a total of 12 sessions . Patients were assessed before treatment ( BT ) , after treatment ( AT ) , and at a three-month follow-up ( F ) . Outcome measures included visual analogue scale , Western Ontario and McMaster University Osteoarthritis Index , six minute walking distance , isokinetic muscle testing , Short Form 36 and Beck depression index . RESULTS The patients with OA in each group had significant improvements in pain , disability , depression , walking distance , muscle strength , and quality of life AT and F when compared with their initial status ( P<0.05 ) . There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test ( P>0.05 ) except some isokinetic peak torque measurements ( F-BT scores of extension right 60 ° , 120 ° and flexion right 60 ° ) . CONCLUSION Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain , disability , walking distance , muscle strength , quality of life and depression in patients with knee OA . CLINICAL REHABILITATION IMPACT Considering the time and cost of combination therapy is now , the isokinetic exercise program , as it is efficient , may be preferable for the treatment of knee OA , alone Osteoarthritis ( OA ) is a common chronic and progressive degenerative joint condition . A major consequence of knee OA is physical disability ; especially difficulty with activities requiring ambulation and transfer , which are necessary to maintain independence and a good quality of life . The purpose s of this study were to determine the efficacy of a muscle exercise program along with education about knee care , and investigate the clinical factors which influence its therapeutic efficacy . A prospect i ve study was carried out among elderly Thai people aged 60 years and over , living in an urban community of the Bangkok metropolitan area around Siriraj Hospital , between October 1997 and September 1999 . The number of elderly people with osteoarthritis of the knee was 392 ( male : female=86:306 ) with a mean age of 67.7+/-6 years . They were interviewed for demographic data and information about their symptoms . The range of the knee movement , quadriceps strength and the six-minute walking distance and a knee X-ray were evaluated . Group exercise was arranged twice a week for 8 weeks for the intervention group only . The results of the study revealed that the quadriceps strength in the intervention group had a tendency to increase and the walking distance was significantly improved especially in the first two months but there was a tendency to decline by the sixth and twelfth month after enrollment . On the other h and , there was no statistically significant difference of both important outcomes for the control group when assessed in the second month . The findings at the sixth and twelfth month after enrollment were that the quadriceps strength was slightly increased but the walking distance was decreased when compared with the initial assessment . An exercise frequency of 12 sessions in two months was sufficient to improve muscle strength and walking distance . Group exercise produces a significant improvement in strength and walking ability , especially in the first two months . Deterioration over time could be due to multiple factors , such as lack of regular exercise , lack of motivation , lack of family support or poor economic status , so we should encourage the elderly to exercise regularly Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis ( OA ) . DESIGN Single-blind r and omized controlled trial . SETTING Exercise gymnasium and community dwellings . PARTICIPANTS Individuals with medial compartment knee OA ( N=40 ) . INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention ( nonintervention group ) . MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale ( CB&M ) , and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale . Secondary outcomes included knee pain , fear of movement , knee joint proprioception , and muscle strength . RESULTS Forty individuals underwent baseline testing , with 36 participants completing follow-up testing .  Adherence to exercise in the training group was high , with 82.2 % of all home-based exercise sessions completed . No significant changes were observed in any outcome in the nonintervention group at follow-up . Significant improvements in self-reported pain , physical function , and fear of movement were observed in the training group when compared with the nonintervention group . No other within- or between-group differences were observed . CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain , physical function , and fear of movement ; however , there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance Background and Purpose : Muscle strength training is important for people with knee osteoarthritis ( OA ) .  High-resistance exercise has been demonstrated to be more beneficial than low-resistance exercise for young subjects . The purpose of this study was to compare the effects of high- and low-resistance strength training in elderly subjects with knee OA . Subjects and Methods : One hundred two subjects were r and omly assigned to groups that received 8 weeks of high-resistance exercise ( HR group ) , 8 weeks of low-resistance exercise ( LR group ) , or no exercise ( control group ) . Pain , function , walking time , and muscle torque were examined before and after intervention . Results : Significant improvement for all measures was observed in both exercise groups . There was no significant difference in any measures between HR and LR groups . However , based on effect size between exercise and control groups , the HR group improved more than the LR group . Discussion and Conclusion : Both high- and low-resistance strength training significantly improved clinical effects in this study . The effects of high-resistance strength training appear to be larger than those of low-resistance strength training for people with mild to moderate knee OA , although the differences between the HR and LR groups were not statistically significant OBJECTIVE Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients , and this r and omized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis ( OA ) at the completion of a 12-week tai chi exercise program . METHODS Seventy-two patients with OA were r and omly assigned into 2 groups . Due to a 41 % overall dropout rate , 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval . Outcome variables were physical symptoms and fitness , body mass index , cardiovascular functioning , and perceived difficulties in physical functioning . The independent t test was used to examine group differences . RESULTS The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures . Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain ( t = -2.19 , p = 0.034 ) and stiffness ( t = -2.13 , p = 0.039 ) in their joints , and reported fewer perceived difficulties in physical functioning ( t = -2.81 , p = 0.008 ) , while the control group showed no change or even deterioration in physical functioning after 12 weeks . In the physical fitness test , there were significant improvements in balance ( t = 3.34 , p = 0.002 ) and abdominal muscle strength ( t = 2.74 , p = 0.009 ) for the tai chi exercise group . No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores . CONCLUSION Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks , and this was effective in improving their arthritic symptoms , balance , and physical functioning . A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management INTRODUCTION Osteoarthritis ( OA ) is a common degenerative joint disease particularly in older subjects . It is usually associated with pain , restricted range of motion , muscle weakness , difficulties in daily living activities and impaired quality of life . To determine the effects of adding two different intensities of low-level laser therapy ( LLLT ) to exercise training program on pain severity , joint stiffness , physical function , isometric muscle strength , range of motion of the knee , and quality of life in older subjects with knee OA . METHODS Patients were r and omly assigned into three groups . They received 16 sessions , 2 sessions/week for 8 weeks . Group-I : 18 patients were treated with a laser dose of 6 J/cm(2 ) with a total dose of 48 J. Group-II : 18 patients were treated with a laser dose of 3 J/cm(2 ) with a total dose of 27 J. Group-III : 15 patients were treated with laser without emission as a placebo . All patients received same exercise training program including stretching and strengthening exercises . Patients were evaluated before and after intervention by visual analogue scale ( VAS ) , the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index for quality of life , h and held dynamometer and universal goniometer . RESULTS T test revealed that there was a significant reduction in VAS and pain intensity , an increase in isometric muscle strength and range of motion of the knee as well as increase in physical functional ability in three treatment groups . Also analysis of variance ( ANOVA ) proved significant differences among them and the post hoc tests ( LSD ) test showed the best improvements for patients of the first group . CONCLUSION It can be concluded that addition of LLLT to exercise training program is more effective than exercise training alone in the treatment of older patients with chronic knee OA and the rate of improvement may be dose dependent , as with 6 J/cm(2 ) or 3 J/cm(2 ) OBJECTIVE To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA Objective : To determine the effect of a progressive resistance exercise ( PRE ) program on women with osteoarthritis ( OA ) of the knee . Methods : Eligible subjects included women aged 40 to 70 years with pain between 3 and 8 on a 10-cm pain scale . Among the 144 subjects screened , 60 met the eligibility criteria and were r and omized to the experimental group ( EG ) or control group ( CG ) . Subjects in the EG participated in a 12-week PRE program twice a week and CG remained on a waiting list for physical therapy . The PRE program consisted of strengthening exercises for knee extensors , knee flexors , hip abductors and hip adductors , all performed with 50 % and 70 % of the one-repetition maximum ( 1RM ) using machines with free weights . Resistance was reevaluated every two weeks . Assessment s of pain , muscle strength , walking distance , function and quality of life were performed at baseline , six weeks and 12 weeks by a blinded assessor . Results : Twenty-nine female subjects were r and omly assigned to the EG and 31 were r and omly assigned to the CG . Repeated- measures ANOVA revealed significantly better results in the EG pain ( from 7.0±1.3 to 4.3±3.1 in the EG and from 7.0±1.2 to 6.6±1.5 in the CG - p<0.001 ) , function ( p<0.001 ) , some domains of quality of life ( physical function : p=0.002 ; physical role limitation : p=0.002 ; and pain : p=0.044 ) and muscle strength ( extensors : p<0.001 ; flexors : p=0.002 ; and abductors : p<0.001 ) . Conclusion : The PRE program was effective in reducing pain and improving function , some quality of life domains and strength in women with OA of the knee Objective . Arthritis and its associated joint pain act as significant barriers for adults attempting to perform l and -based physical activity . Swimming can be an ideal form of exercise for patients with arthritis . Yet there is no information on the efficacy of regular swimming exercise involving patients with arthritis . The effect of a swimming exercise intervention on joint pain , stiffness , and physical function was evaluated in patients with osteoarthritis ( OA ) . Methods . Using a r and omized study design , 48 sedentary middle-aged and older adults with OA underwent 3 months of either swimming or cycling exercise training . Supervised exercise training was performed for 45 min/day , 3 days/week at 60–70 % heart rate reserve for 12 weeks . The Western Ontario and McMaster Universities Arthritis Index was used to measure joint pain , stiffness , and physical limitation . Results . After the exercise interventions , there were significant reductions in joint pain , stiffness , and physical limitation accompanied by increases in quality of life in both groups ( all p < 0.05 ) . Functional capacity as assessed by maximal h and grip strength , isokinetic knee extension and flexion power ( 15–30 % increases ) , and the distance covered in the 6-min walk test increased ( all p < 0.05 ) in both exercise groups . No differences were observed in the magnitude of improvements between swimming and cycling training . Conclusion . Regular swimming exercise reduced joint pain and stiffness associated with OA and improved muscle strength and functional capacity in middle-aged and older adults with OA . Additionally , the benefits of swimming exercise were similar to the more frequently prescribed l and -based cycling training . Trial registration : clinical trials.gov NCT01836380 Background Sarcopenic obesity is a health condition that combines excess adipose tissue and loss of muscle mass and strength . Sarcopenic obesity predisposes to more functional disabilities than obesity or sarcopenia alone . Progressive resistance exercises are recommended for older people as a potential treatment for sarcopenia and also for obesity . However , there is a lack of evidence indicating which programmes are best applied to older people , and no studies have investigated their effects on sarcopenic obese people . The aims of this protocol study are to investigate and compare the efficacy of l and -based and aquatic resistance exercise programmes on improving muscle performance , functional capacity and quality of life of older women with sarcopenic obesity . Methods / Design This is a protocol study for a parallel r and omised controlled clinical trial . Eligible participants are older women ( ≥65 years ) with a body mass index ≥30 kg/m 2 and h and grip strength ≤21 kg force . A total sample of 36 participants will be r and omly allocated to one of the intervention groups in blocks of three : l and -based , aquatic or control . Each intervention group will undergo 2-week sessions of a 10-week therapeutic exercise programme for strength , power and endurance training of the lower-limb muscles . Participants in the control group will not participate in any strengthening activity for lower limbs and will receive telephone calls once a week . Baseline and final evaluation of outcomes will encompass muscle performance of the lower limbs assessed by an isokinetic dynamometer ; functional tests of usual walking speed , maximal walking speed ( shuttle walking test ) , stair speed and the Short Physical Performance Battery ; and health-related quality of life ( Medical Outcomes Study Short Form Question naire – SF-36 ) . Data collectors will be blinded to r and omisation and will not be in touch with participants during the interventions . Discussion This study is the first r and omised controlled trial design ed to evaluate resistance exercises in older patients with sarcopenic obesity . If our hypothesis proves correct , both intervention programmes will be effective , with the l and -based exercises conferring better results in muscle performance . Trial registration Registro Brasileiro de Ensaios Clínicos : Abstract Bressel , E , Wing , JE , Miller , AI , and Dolny , DG . High-intensity interval training on an aquatic treadmill in adults with osteoarthritis :  effect on pain , balance , function , and mobility . J Strength Cond Res 28(8 ) : 2088–2096 , 2014—Although aquatic exercise is considered a potentially effective treatment intervention for people with osteoarthritis ( OA ) , previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity . The purpose of this study was to quantify the efficacy of a 6-week aquatic treadmill exercise program on measures of pain , balance , function , and mobility .  Eighteen participants ( age = 64.5 ± 10.2 years ) with knee OA completed a non-exercise control period followed by a 6-week exercise period . Outcome measures included visual analog scales for pain , posturography for balance , sit-to-st and test for function , and a 10-m walk test for mobility . The exercise protocol included balance training and high-intensity interval training ( HIT ) in an aquatic treadmill using water jets to destabilize while st and ing and achieve high ratings of perceived exertion ( 14–19 ) while walking . In comparison with pretests , participants displayed reduced joint pain ( pre = 50.3 ± 24.8 mm vs. post = 15.8 ± 10.6 mm ) , improved balance ( equilibrium pre = 66.6 ± 11.0 vs. post = 73.5 ± 7.1 ) , function ( rising index pre = 0.49 ± 0.19 % vs. post = 0.33 ± 0.11 % ) , and mobility ( walk pre = 8.6 ± 1.4 s vs. post = 7.8 ± 1.1 s ) after participating in the exercise protocol ( p = 0.03–0.001 ) . The same benefits were not observed after the non-exercise control period . Adherence to the exercise protocol was exceptional and no participants reported adverse effects , suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by patients with OA and may be effective at managing symptoms of OA Background Knee osteoarthritis ( OA ) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability . Many people with knee OA also experience co-morbidities that further add to the OA burden . Uptake of and adherence to physical activity recommendations is suboptimal in this patient population , leading to poorer OA outcomes and greater impact of associated co-morbidities . This pragmatic r and omised controlled trial will investigate the clinical - and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA . Methods / Design 168 people with clinical ly diagnosed knee OA will be recruited from the community in metropolitan and regional areas and r and omly allocated to physiotherapy only , or physiotherapy plus nurse-delivered telephone coaching . Physiotherapy involves five treatment sessions over 6 months , incorporating a home exercise program of 4–6 exercises ( targeting knee extensor and hip abductor strength ) and advice to increase daily physical activity . Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia ( HCA ) Model of Health Change to provide behaviour change support . The telephone coaching intervention aims to maximise adherence to the physiotherapy program , as well as facilitate increased levels of participation in general physical activity . The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months . Secondary outcomes include physical activity levels , quality -of-life , and potential moderators and mediators of outcomes including self-efficacy , pain coping and depression . Relative cost-effectiveness will be determined from health service usage and outcome data . Follow-up assessment s will also occur at 12 and 18 months . Discussion The findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Strengthening exercises of the quadriceps femoris muscle ( QFM ) are beneficial for patients with knee osteoarthritis ( OA ) . Studies reporting short-term effects of neuromuscular electrical stimulation ( NMES ) of the QFM in this population support the use of this modality as an adjunct treatment . The objectives of this follow-up study are to compare the effects of an exercise program with and without NMES of the QFM on pain , functional performance , and muscle strength immediately posttreatment and 12 weeks after completion of the intervention . Methods Sixty-three participants with knee OA were r and omly assigned into two groups receiving 12 biweekly treatments : An exercise-only program or an exercise program combined with NMES . Results A significantly greater reduction in knee pain was observed immediately after treatment in the NMES group , which was maintained 12 weeks postintervention in both groups . Although at this stage NMES had no additive effect , both groups demonstrated an immediate increase in muscle strength and in functional abilities , with no differences between groups . Although the improvements in gait velocity and in self-report functional ability were maintained at the follow-up session , the noted improvements in muscle strength , time to up and go , and stair negotiation were not maintained . Conclusion Supplementing an exercise program with NMES to the QFM increased pain modulation immediately after treatment in patients with knee OA . Maintenance of the positive posttreatment effects during a 12-week period was observed only for pain , self-reported functional ability , and walk velocity , with no difference between groups . Clinical rehabilitation effect The effects of a comprehensive group exercise program with or without NMES are partially maintained 12 weeks after completion of the intervention . The addition of NMES is recommended primarily for its immediate effect on pain . Further studies are necessary to determine the effects of repeated bouts of exercise with and without NMES in this population Objective The aim of this study was to assess whether the effects of a motorized aquatic treadmill exercise program improve the isometric strength of the knee muscles , cardiorespiratory fitness , arterial stiffness , motor function , balance , functional outcomes , and quality of life in subacute stroke patients . Design Thirty-two patients were r and omly assigned to 4-wk training sessions of either aquatic therapy ( n = 19 ) or l and -based aerobic exercise ( n = 18 ) . Isometric strength was measured using an isokinetic dynamometer . Cardiopulmonary fitness was evaluated using a symptom-limited exercise tolerance test and by measuring brachial ankle pulse wave velocity . Moreover , motor function ( Fugl-Meyer Assessment [ FMA ] and FMA-lower limb [ FMA-LL ] ) , balance ( Berg Balance Scale [ BBS ] ) , Activities of daily living ( Korean version of the Modified Barthel Index [ K-MBI ] ) , and quality of life ( EQ-5D index ) were examined . Results There were no intergroup differences between demographic and clinical characteristics at baseline ( P > 0.05 ) . The results shows significant improvements in peak oxygen consumption ( P = 0.02 ) , maximal isometric strength of the bilateral knee extensors ( P < 0.01 ) and paretic knee flexors ( P = 0.01 ) , FMA ( P = 0.03 ) , FMA-LL ( P = 0.01 ) , BBS ( P = 0.01 ) , K-MBI ( P < 0.01 ) , and EQ-5D index ( P = 0.04 ) after treatment in the aquatic therapy group . However , only significant improvements in maximal isometric strength in the knee extensors ( P = 0.03 ) and flexors ( P = 0.04 ) were found within the aquatic therapy group and control group . Conclusions Water-based aerobic exercise performed on a motorized aquatic treadmill had beneficial effect on isometric muscle strength in the lower limb . To Cl aim CME Credits Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article , the reader should be able to : ( 1 ) Articulate the rationale for including walking on an aquatic treadmill in the rehabilitation of subacute stroke patients ; ( 2 ) Describe the beneficial effects of a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients ; and ( 3 ) Determine the appropriate indications for incorporating a motorized aquatic treadmill exercise program in the rehabilitation of subacute stroke patients . Level : Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians . The Association of Academic Physiatrists design ates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should only cl aim credit commensurate with the extent of their participation in the activity OBJECTIVE To investigate whether an exercise program , initially focusing on knee stabilization and subsequently on muscle strength and performance of daily activities is more effective than an exercise program focusing on muscle strength and performance of daily activities only , in reducing activity limitations in patients with knee osteoarthritis ( OA ) and instability of the knee joint . DESIGN A single-blind , r and omized , controlled trial involving 159 knee OA patients with self-reported and /or biomechanically assessed knee instability , r and omly assigned to two treatment groups . Both groups received a supervised exercise program for 12 weeks , consisting of muscle strengthening exercises and training of daily activities , but only in the experimental group specific knee joint stabilization training was provided . Outcome measures included activity limitations ( Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC physical function , primary outcome ) , pain , global perceived effect and knee stability . RESULTS Both treatment groups demonstrated large ( ∼20 - 40 % ) and clinical ly relevant reductions in activity limitations , pain and knee instability , which were sustained 6 months post-treatment . No differences in effectiveness between experimental and control treatment were found on WOMAC physical function ( B ( 95 % confidence interval - CI ) = -0.01 ( -2.58 to 2.57 ) ) or secondary outcome measures , except for a higher global perceived effect in the experimental group ( P = 0.04 ) . CONCLUSIONS Both exercise programs were highly effective in reducing activity limitations and pain and restoring knee stability in knee OA patients with instability of the knee . In knee OA patients suffering from knee instability  , specific knee joint stabilization training , in addition to muscle strengthening and functional exercises , does not seem to have any additional value . Dutch Trial Register ( NTR ) registration number : NTR1475 OBJECTIVE To compare the effects of a hydrotherapy resistance exercise programme with a gym based resistance exercise programme on strength and function in the treatment of osteoarthritis ( OA ) . DESIGN Single blind , three arm , r and omised controlled trial . SUBJECTS 105 community living participants aged 50 years and over with clinical OA of the hip or knee . METHODS Participants were r and omised into one of three groups : hydrotherapy ( n = 35 ) , gym ( n = 35 ) , or control ( n = 35 ) . The two exercising groups had three exercise sessions a week for six weeks . At six weeks an independent physiotherapist unaware of the treatment allocation performed all outcome assessment s ( muscle strength dynamometry , six minute walk test , WOMAC OA Index , total drugs , SF-12 quality of life , Adelaide Activities Profile , and the Arthritis Self-Efficacy Scale ) . RESULTS In the gym group both left and right quadriceps significantly increased in strength compared with the control group , and right quadriceps strength was also significantly better than in the hydrotherapy group . The hydrotherapy group increased left quadriceps strength only at follow up , and this was significantly different from the control group . The hydrotherapy group was significantly different from the control group for distance walked and the physical component of the SF-12 . The gym group was significantly different from the control group for walk speed and self efficacy satisfaction . Compliance rates were similar for both exercise groups , with 84 % of hydrotherapy and 75 % of gym sessions attended . There were no differences in drug use between groups over the study period . CONCLUSION Functional gains were achieved with both exercise programmes compared with the control group The aim of this study was to evaluate effects of electrical stimulation combined with continuous passive motion ( CPM – ES ) versus isometric exercise on symptoms , functional capacity , quality of life , muscle strength , knee and thigh circle measurements , and balance in knee osteoarthritis ( OA ) . This is a r and omized clinical trial . The study was done in Gulhane Military Medical Academy ( GMMA ) Rehabilitation Center . Forty patients with knee OA were included in this study . Participants were r and omly assigned to two groups : 20 patients placed in Group 1 were treated with conventional physical therapy and CPM – ES combination ; 20 patients in Group 2 were treated with conventional physical therapy and isometric exercise . Therapies were applied 3 weeks , 5 days per week . The following main outcome measures were done : values of pain ( VAS was used ) , WOMAC , SF-36 , knee and thigh circle measurements , isokinetic tests , dynamic and static balance tests were determined at baseline and after the treatment . There were no statistically significant differences in the tested variables between the groups for post-treatment values . Dynamic and static balance test improved statistically strongly significantly in both groups . The findings of this study demonstrate that knee OA patients could improve their balance function in both static and dynamic conditions after CPM – ES combination or isometric exercise therapy . The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities PURPOSE The purpose of this study was to identify the effects of water-based exercises on the physical functions and quality of life ( QOL ) in community-dwelling elderly people with history of falling . MATERIAL S AND METHODS Participants were r and omly assigned to the water-based exercise group ( n=34 ) or l and -based exercise groups ( n=32 ) . To identify the effects on physical functions , muscle strength , flexibility , and mobility were measured . QOL and fear of falling were evaluated using the Short Form 36-item question naire and the modified falls efficacy scale ( M-FES ) . The measurements were performed before and after the 10-week training period . RESULTS Within-group analysis indicated that hip abduction and adduction strength improved significantly in both groups ( p=0.005 ; p=0.007 ) . However , no statistically significant within-group differences were found in the back scratch test ( p=0.766 ) and chair sit- and -reach test ( p=0.870 ) . QOL was significantly different in both groups ( health transition : p=0.014 , physical functioning : p<0.001 , role physical : p<0.001 , role emotional : p=0.002 , bodily pain : p<0.001 , vitality : p<0.001 , and mental health : p<0.001 ) . There was a significant difference in the M-FES in both groups ( p=0.040 ) . CONCLUSIONS These results indicate that water-based exercises are beneficial to improve the QOL , as well as physical activities , of community-dwelling elderly compared with l and -based exercise . Water-based exercises would be useful to improve physical and psychological health in the elderly people with history of falling Objective : To examine the effectiveness of a 12-month community-based water exercise programme on measures of self-reported health and physical function in people aged over 60 years old with knee-hip osteoarthritis ( OA ) . Design : A quasi-experimental design consisting of an exercise group and an age-matched control group . Setting : Public community swimming pool in Sheffield , UK . Subjects : One hundred and six community-dwelling sedentary older people , with confirmed knee-hip osteoarthritis , enrolled in an experimental controlled trial for 12 months . Sixty-six subjects in the exercise group were offered a water-exercise programme .  Forty age-matched , nonexercising , ‘ control ’ subjects received monthly education material and quarterly telephone calls . Interventions : Participants in the exercise group were asked to attend two exercise sessions a week of 1 hour duration led by specially trained swimming instructors . Main measures : Primary outcome measure was the disease-specific Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) . Secondary outcomes included a battery of performance-based physical function tests . Results : Adherence to exercise averaged 70 % ( ±14 % ) over the year : 77 % of the exercising subjects and 89 % control subjects completed both pre- and post- outcome measures . After one year , participants in the exercise group experienced a significant improvement in physical function ( 4.0 ± 9.1 versus -0.4 ± 7.3 units ; 95 % confidence interval ( CI ) 0.96–7.96 , p < 0.05 ) and reduction in the perception of pain ( 1.3 ± 3.7 versus 0.2 ± 2.5 units ; 95 % CI -0.19 - 2.52 , p < 0.05 ) compared with the control group , as measured by the WOMAC Osteoarthritis Index . In addition , the exercise group performed significantly better in the ascending and descending stairs tests ( p < 0.05 ) , had significantly greater improvements in knee range of movement ( p < 0.01 ) and hip range of movements ( p < 0.005 ) . There were no significant differences in the two groups for quadriceps muscle strength and psychosocial well-being ( Arthritis Impact Measurement Scales 2 question naire ) . Conclusions : Older people with knee/hip osteoarthritis gained modest improvements in measures of physical function , pain , general mobility and flexibility after participating in 12 months of community-based water exercise The feasibility and efficacy of an additional progressive home-based strengthening exercise program ( PHSEP ) on subjects that already attended supervised institutional exercise therapy  was investigated . Thirty-six hip patients with hip osteoarthritis ( OA ) and /or total hip replacement in at least one hip joint were r and omly assigned to an intervention group ( IG ) or a control group ( CG ) . IG ( 18 patients , mean age 64.9 , st and ard deviation ( SD ) 7.5 ) followed an 8-week PHSEP in addition to their weekly institutional exercise therapy , while CG ( 18 patients , mean age 64.7 , SD 9 ) solely continued the weekly institutional exercise sessions . Before and after the intervention period , strength of hip muscles was quantified applying isokinetic concentric and isometric measurements , and health-related quality of life was monitored using the SF36 question naire . Adherence to the exercise program was evaluated using exercise logs . The PHSEP was feasible for all subjects in IG with an adherence of 99 % . Exercise logs reported that pain result ing from the PHSEP was low . Increased strength in isokinetic concentric hip adduction ( 13 % ) and isometric hip abduction ( 9 % ) , adduction ( 12 % ) , and flexion ( 7 % ) was found in IG in comparison to CG . The results of the SF36 did not change during the intervention period . Consequently , supervised institutional exercise therapy supplemented by a PHSEP could increase hip muscle strength in patients with hip OA and /or total hip replacement . However , further research should evaluate the optimal frequency and duration of such supplementary sessions and their potential to increase physical function and reduce pain
Beneficial effects of aquatic exercise were found on physical function .
Water-based exercises are recommended for people with osteoarthritis ( OA ) , due to the beneficial effects on physical function , quality of life and symptom reduction .
However , the effects on muscle strength are still controversial .
The aim of this review was to assess and compare the effects of aquatic exercise programs on muscle strength and physical function in people with OA .