Knee pain, knee osteoarthritis, and the risk of fracture. 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 Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis. Functional performance and inflammatory cytokines after squat exercises and whole-body vibration in elderly individuals with knee osteoarthritis. Occupational physical loading tasks and knee osteoarthritis: a review of the evidence. Agility and Perturbation Training Techniques in Exercise Therapy for Reducing Pain and Improving Function in People With Knee Osteoarthritis: A Randomized Clinical Trial A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Clinical effects of lateral wedge arch support insoles in knee osteoarthritis Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Physical activity, muscle function, falls and fractures Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women's Midlife Health Project. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial. Effects of Kinesthesia and Balance Exercises in Knee Osteoarthritis Incidence and predictors of falls in the chinese elderly. The effectiveness of self‐management educational interventions for osteoarthritis of the knee Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results.
OBJECTIVE Patients with osteoarthritis ( OA ) have increased bone mineral density ; however , the association between knee OA and fracture is controversial . Few data exist on the association between knee pain and fracture . We examined the association of knee OA and knee pain with fracture and falls in elderly men and women . METHODS The study group comprised 6,641 men and women ages > or = 75 years who participated in a 3-year r and omized controlled trial of intramuscular vitamin D therapy .  Patients completed a question naire about knee pain and OA .  Fracture and fall data were collected prospect ively every 6 months . RESULTS Knee pain prevalence and a clinician diagnosis of knee OA were 35.2 % and 6.8 % , respectively . A total of 436 incident nonvertebral fractures were reported , and 3,992 patients sustained a fall . Prevalent knee pain was associated with an increased risk of falls ( hazard ratio [ HR ] 1.26 , 95 % confidence interval [ 95 % CI ] 1.17 - 1.36 ) and hip fracture ( HR 2.0 , 95 % CI 1.18 - 3.37 ) . Increasing severity of knee pain was associated with a greater risk of falls and hip fracture . Clinician diagnosis of knee OA was associated with an increased risk of nonvertebral fractures ( HR 1.61 , 95 % CI 1.09 - 2.36 ) . The increased risk of fracture was not substantially reduced by adjusting for falls , but was attenuated by adjustment for the use of walking aids . CONCLUSION Patients with a clinical diagnosis of knee OA and with knee pain have an increased risk of nonvertebral and hip fracture . This is not explained by the increased risk of falls , but is more likely to be due to the severity of falls sustained . Knee pain and OA should be regarded as independent risk factors for fracture 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 Patients with knee osteoarthritis ( OA ) find that use of elastic knee sleeves gives them partial pain relief and a greater sense of joint stability . However , the scientific effects of knee OA patients wearing braces are unclear . The purpose of this study was to investigate the effects of knee sleeves on static and dynamic balance in knee OA patients . Fifty patients with knee OA were enrolled in the study and all subjects were r and omly divided into two groups . Initially , subjects in group A did not wear a neoprene sleeve while receiving balance tests but then wore them to be re-tested . Subjects in group B did just the reverse procedure . In this investigation , an instrument ( KAT 2000 ; Breg Inc. , Vista , CA , USA ) , which quantified motor control performance of the lower extremities was used and balance scores from the KAT 2000 software were obtained . The results revealed that the scores of patients wearing braces were significantly lower than those of patients without braces ( p < 0.05).The finding of this study demonstrated that knee OA patients wearing knee sleeves could experience increased balance ability in both static and dynamic conditions . The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities OBJECTIVE To investigate the effects of squat exercises combined with whole-body vibration on the plasma concentration of inflammatory markers and the functional performance of elderly individuals with knee osteoarthritis ( OA ) . DESIGN Clinical , prospect i ve , r and omized , single-blinded study . SETTING Exercise physiology laboratory . PARTICIPANTS Elderly subjects with knee OA ( N=32 ) were divided into 3 groups : ( 1 ) squat exercises on a vibratory platform ( platform group , n=11 ) ; ( 2 ) squat exercises without vibration ( squat group , n=10 ) ; and ( 3 ) the control group ( n=11 ) . INTERVENTIONS The structured program of squat exercises in the platform and squat groups was conducted 3 times per week , on alternate days , for 12 weeks . MAIN OUTCOME MEASURES Plasma soluble tumor necrosis factor-α receptors 1 ( sTNFR1 ) and 2 ( sTNFR2 ) were measured using immunoassays ( the enzyme-linked immunosorbent assay method ) . The Western Ontario and McMaster Universities Osteoarthritis Index question naire was used to evaluate self-reported physical function , pain , and stiffness . The 6-minute walk test , the Berg Balance Scale , and gait speed were used to evaluate physical function . RESULTS In the platform group , there were significant reductions in the plasma concentrations of the inflammatory markers sTNFR1 and sTNFR2 ( P<.001 and P<.05 , respectively ) and self-reported pain ( P<.05 ) compared with the control group , and there was an increase in balance ( P<.05 ) and speed and distance walked ( P<.05 and P<.001 , respectively ) . In addition , the platform group walked faster than the squat group ( P<.01 ) . CONCLUSIONS The results suggest that whole-body vibration training improves self-perception of pain , balance , gait quality , and inflammatory markers in elderly subjects with knee OA UNLABELLED Purpose : To perform a systematic review with best evidence synthesis examining the literature on the relationship between occupational loading tasks and  knee osteoarthritis ( OA ) . METHODS Two data bases were search ed to identify articles published between 1946 and April , 2011 . Eligible studies were those that ( 1 ) included adults reporting on their employment history ; ( 2 ) measured individuals ' exposure to work-related activities with heavy loading in the knee joint ; and ( 3 ) identified presence of knee OA ( determined by X-ray ) , cartilage defects associated with knee OA ( identified by magnetic resonance imaging ) , or joint replacement surgery . RESULTS A total of 32 articles from 31 studies met the inclusion criteria . We found moderate evidence that combined heavy lifting and kneeling is a risk factor for knee OA , with odds ratios ( OR ) varying from 1.8 to 7.9 , and limited evidence for heavy lifting ( OR=1.4 - 7.3 ) , kneeling ( OR=1.5 - 6.9 ) , stair climbing ( OR=1.6 - 5.1 ) , and occupational groups ( OR=1.4 - 4.7 ) as risk factors . When examined by sex , moderate level evidence of knee OA was found in men ; however , the evidence in women was limited . CONCLUSIONS Further high- quality prospect i ve studies are warranted to provide further evidence on the role of occupational loading tasks in knee OA , particularly in women Background Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis ( OA ) . It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function . Objective The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to st and ard exercise therapy compared with the st and ard exercise program alone for people with knee OA . Design This was a single-blinded r and omized controlled trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise program . Measurements The outcome measures were self-reported knee pain and function , self-reported knee instability , a performance-based measure of function , and global rating of change . Results Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2- , 6- , and 12-month follow-up periods , there were no differences between groups on these outcomes . There was no reduction in knee pain or improvement in performance-based function in either group . Limitations It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach . Conclusions Both intervention groups exhibited improvement in self-reported function and the global rating of change . Our results , however , did not support an additive effect of agility and perturbation training with st and ard exercise therapy in our sample of individuals with knee OA . Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach OBJECTIVE To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis ( OA ) . DESIGN R and omized controlled trial . SETTING Community . PARTICIPANTS Persons ( N=39 ; mean±SD age , 74±6y ; 26 women ) with mild to moderate OA and at risk for falling met study criteria , were measured at baseline , and were r and omly assigned to the intervention ( n=23 ) and control groups ( n=16 ) . INTERVENTIONS Water-based program ( 12wk , twice weekly ; intervention group ) or a time-matched computer training program ( control group ) . MAIN OUTCOME MEASURE The primary outcome was the short-form Physiological Profile Assessment ( PPA ) . Secondary outcomes included the Step Test , Timed Up and Go Test , Western Ontario and McMaster Universities OA Index ( Likert 3.0 version ) , Arthritis Impact Measurement Scales 2 , and Activity-specific Balance Confidence Scale . RESULTS No statistically significant between-group differences were found for any outcome measured ( n=35 ; 4 lost to follow-up ) . Within-group analysis indicated that Step Test results improved significantly in both groups ( mean change : control group , left leg , 2.07 ; 95 % confidence interval , 3.19-.95 ; P=.002 ; intervention group , 2.14 ; 95 % confidence interval , 3.20 - 1.08 ; P=.000 ) . Two PPA item scores ( reaction time , contrast sensitivity ) improved significantly ( 86.83 ; 95 % confidence interval , 9.86 - 163.79 ; P=.03 ; 1.43 ; 95 % confidence interval , 2.35-.50 ; P=.005 , respectively ) in the control group , result ing in a lower falls risk score . CONCLUSIONS Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class . Our study is , to our knowledge , the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity . Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation Abstract We compared the short-term efficacy of rigid versus soft lateral wedge arch support ( LWAS ) insoles for patients with knee osteoarthritis ( OA ) , as assessed using the International Classification of Functioning , Disability and Health ( ICF ) system , through a prospect i ve , double-blind , r and omized controlled trial . Participants who fulfilled the combined radiographic and clinical criteria for knee OA , as defined by the American College of Rheumatology , were r and omly prescribed 1  pair of rigid or soft LWAS insoles . Body functions and structures were evaluated according to Kellgren – Lawrence scores , the Foot Posture Index , Hospital Anxiety and Depression Scale scores , the pain – pressure threshold , postural stability , dynamic balance , and fall risk ; activities and participation were assessed according to 10-m fast speed walking , stair climbing and chair rising times , and Chronic Pain Grade question naire responses ; and knee OA-related health status was evaluated using the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) . Hospital Anxiety and Depression Scale scores , the pain – pressure threshold , physical activity , balance , Chronic Pain Grade question naire responses , and the KOOS were recorded before treatment and at 1- , 2- , and 3-month follow-ups . We enrolled 90 participants , 70 women and 20 men , with mean ages of 60.6 ± 10.8 and 63.1 ± 10.8 years in the rigid and soft LWAS insole groups , respectively . Repeated- measures analysis of covariance revealed significant time × group effect improvements in pain ( P = 0.008 for the KOOS ) , stair ascent time ( P = 0.003 ) , daily living function ( P = 0.003 for the KOOS ) , sports and recreation function ( P = 0.012 for the KOOS ) , and quality of life ( P = 0.021 for the KOOS ) in the soft LWAS insole group . Patients with knee OA  who used soft LWAS insoles for a short term showed more significant improvement than did those who used rigid LWAS insoles  in pain , physical activity , daily living function , sports and recreation function , and quality of life , which belong to the body functions and structures and the activities and participation components in the ICF scheme 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 OBJECTIVE To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis ( OA ) . METHOD Seventy-nine adults , 65 years of age or older with hip OA and at least 1 fall risk factor , were r and omly assigned to 1 of 3 groups : aquatics and education ( AE ; aquatic exercise twice a wk with once-a-wk group education ) , aquatics only ( A ; 2 wk aquatic exercise ) and control ( C ; usual activity ) . Balance , falls efficacy , dual-task function , functional performance ( chair st and s ) , and walking performance were measured pre- and postintervention or control period . RESULTS There was a significant improvement in fall risk factors ( full-factorial MANCOVA , baseline values as covariates ; p = .038 ) ; AE improved in falls efficacy compared with C and in functional performance compared with A and C. CONCLUSION The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis OBJECTIVES This r and omized controlled trial studied the effects of a low- to moderate-intensity group exercise program on strength , endurance , mobility , and fall rates in fall-prone elderly men with chronic impairments . METHODS Fifty-nine community-living men ( mean age = 74 years ) with specific fall risk factors ( i.e. , leg weakness , impaired gait or balance , previous falls ) were r and omly assigned to a control group ( n = 28 ) or to a 12-week group exercise program ( n = 31 ) . Exercise sessions ( 90 minutes , three times per week ) focused on increasing strength and endurance and improving mobility and balance . Outcome measures included isokinetic strength and endurance , five physical performance measures , and self-reported physical functioning , health perception , activity level , and falls . RESULTS Exercisers showed significant improvement in measures of endurance and gait . Isokinetic endurance increased 21 % for right knee flexion and 26 % for extension . Exercisers had a 10 % increase ( p < .05 ) in distance walked in six minutes , and improved ( p < .05 ) scores on an observational gait scale . Isokinetic strength improved only for right knee flexion . Exercise achieved no significant effect on hip or ankle strength , balance , self-reported physical functioning , or number of falls . Activity level increased within the exercise group . When fall rates were adjusted for activity level , the exercisers had a lower 3-month fall rate than controls ( 6 falls/1000 hours of activity vs 16.2 falls/1000 hours , p < .05 ) . DISCUSSION These findings suggest that exercise can improve endurance , strength , gait , and function in chronically impaired , fall-prone elderly persons . In addition , increased physical activity was associated with reduced fall rates when adjusted for level of activity Study design A thematic review . Objectives To evaluate if physical activity enhances muscle strength , improves balance , and reduces the fall frequency and the fracture incidence .  Background One of the major medical problems of today is the increasing incidence of fragility fractures .  Muscle strength and fall is one of the major determinants of a fracture . If physical activity could increase muscle strength , improve balance and reduce the fall frequency , then training could be recommended as prevention for fractures . Methods The review used Medline ( Pub Med ) and the search words exercise , physical activity , muscle strength , balance , falls , fractures . R and omized controlled trials ( RCT ) were predominantly included , although this not is a systematic review . Results The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking . Physical activity is associated with improved muscle strength , co-ordination and balance .  Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass . There is also evidence that physical activity decreases the actual number of falls . Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk . If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated . Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance , to reduce the risk to fall and fractures , although the highest level of evidence – RCT with fracture as endpoint – is lacking The prevalence of  osteoarthritis ( OA )  is greater in women then men . Weight , a factor strongly associated with osteoarthritis , is significantly increased over the menopausal transition . Despite the high prevalence of osteoarthritis , a disabling disease with limited treatment options , there is a paucity of studies in women . The longitudinal phase of the Melbourne Women 's Midlife Health Project , is a population -based prospect i ve study of 438 Australian born women who have been followed annually over 11 years . 257 ( 59 % ) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and h and s. In this study , X-rays were scored for evidence of osteoarthritis using a vali date d scale , by two investigators who were blinded to question naire results . Information on hormone therapy use , physical activity , smoking , BMI and age were obtained by both self-administered and face-to-face question naires . Results showed that one hundred and twenty-eight women ( 56 % ) had evidence of radiological OA . Forty-nine ( 21.6 % ) had evidence of radiological knee OA . One hundred and one ( 44.5 % ) had evidence of radiological h and OA . Compared to baseline , at 11th year of follow-up participants had put on weight ( 4 kg range -14 to 25 kg ) and a larger proportion ( 25 % vs. 40 % ) reported exercising frequently ( P = 0.005 ) . Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up . Smoking was associated with a lower prevalence of radiological knee OA . The prevalence was 61 % among never smokers compared to only 39 % among those who smoked ( P < 0.05 ) . Total OA was associated with never having used hormone therapy ( odds ratio 2.7 ; CI 1.1 - 6.9 ) . There was a trend for increasing level of physical activity at ages 20 - 29 to be associated with an increased risk of knee OA ( P value 0.03 for trend ) . In conclusion increasing age , BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA . In contrast , smoking appeared to be associated with less knee OA . Never having used hormone therapy was a risk factor for radiological h and and knee OA . Further work will be needed to determine whether modification of these factors can prevent the development of OA Objective —To test the efficacy of a community based 10 week exercise intervention to reduce fall risk factors in women with osteoporosis . Methods —Static balance was measured by computerised dynamic posturography ( Equitest ) , dynamic balance by timed figure of eight run , and knee extension strength by dynamometry . Subjects were r and omised to exercise intervention ( twice weekly Osteofit classes for 10 weeks ) or control groups . Results —The outcome in 79 participants ( 39 exercise , 40 control ) who were available for measurement 10 weeks after baseline measurement is reported . After confounding factors had been controlled for , the exercise group did not make significant gains compared with their control counterparts , although there were consistent trends toward greater improvement in all three primary outcome measures . Relative to the change in control subjects , the exercise group improved by 2.3 % in static balance , 1.9 % in dynamic balance , and 13.9 % in knee extension strength . Conclusions —A 10 week community based physical activity intervention did not significantly reduce fall risk factors in women with osteoporosis . However , trends toward improvement in key independent risk factors for falling suggest that a study with greater power may show that these variables can be improved to a level that reaches statistical significance PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling OBJECTIVE To assess the effects of low-frequency electric muscle stimulation associated with usual physiotherapy on functional outcome after total hip arthroplasty ( THA ) for hip osteoarthritis ( OA ) in elderly subjects . DESIGN R and omized controlled trial ; pre- and posttreatment measurements . SETTING Hospital rehabilitation department . PARTICIPANTS Subjects ( N=29 ) referred to the rehabilitation department after THA for hip OA . INTERVENTIONS The intervention group ( n=16 ; 78+/-8 y ) received simultaneous low-frequency electric muscle stimulation of bilateral quadriceps and calf muscles ( highest tolerated intensity , 1h session , 5 d/wk , for 5 weeks ) associated with conventional physical therapy including resistance training . The control group ( n=13 ; 76+/-10 y ) received conventional physical therapy alone ( 25 sessions ) . MAIN OUTCOME MEASURES Maximal isometric strength of knee extensors , FIM instrument , before and after ; a six-minute walk test and a 200 m fast walk test , after ; length of stay ( LOS ) . RESULTS Low-frequency electric muscle stimulation was well tolerated . It result ed in a greater improvement in strength of knee extensors on the operated side ( 77 % vs 23 % ; P<.01 ) , leading to a better balance of muscle strength between the operated and nonoperated limb . The low-frequency electric muscle stimulation group also showed a greater improvement in FIM scores , though improvements in the walk tests were similar for the 2 groups , as was LOS . CONCLUSIONS Low-frequency electric muscle stimulation is a safe , well-tolerated therapy after THA for hip OA . It improves knee extensor strength , which is one of the factors leading to greater functional independence after THA Background : In patients with knee osteoarthritis ( OA ) , there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender . Objectives : The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA . Methods : This 8-week study was conducted on 66 female patients with knee OA who were r and omized into 2 groups . The first group received kinesthesia and balance exercises ( such as retrowalking , walking on their toes , leaning to the sides , balance board exercises , minitrampoline exercises , plyometric exercises , and so on ) in addition to strengthening exercises . The second group received only strengthening exercises . Results : Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC , SF-36 Form , times for performing activities of daily living , isokinetic quadriceps muscle strength , and proprioceptive sensation levels . In the first group with kinesthesia training , compared with the second group , significantly greater improvements were obtained in all the subparameters that measure functional status ( WOMAC – physical function value , SF-36 Form [ physical function , role limitations –physical and vitality – energy or fatigue variables ] , 10 stairs climbing , and 10-m walking times ) and in isokinetic muscle strength at high angular velocities ( P < 0.05 ) . The absolute angular error percentage ( to assess proprioceptive accuracy ) was significantly improved postexercise in both groups . There were no differences between the groups . Conclusions : Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated . Used in clinical applications , they should be able to increase the functional capacities of patients . Long-term studies about efficacy and cost-effectivity of these exercises are needed INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes OBJECTIVE To estimate the prevalence of radiographic and symptomatic knee osteoarthritis ( OA ) in a population -based sample of elderly subjects in Beijing , China and compare it with that reported in the Framingham ( Massachusetts ) OA Study . METHODS We recruited a sample of persons age > or = 60 , using door-to-door enumeration in r and omly selected neighborhoods in Beijing . Subjects completed a home interview including questions on knee symptoms and a hospital examination including knee radiographs obtained during weight bearing . The protocol was identical to that used in the Framingham OA Study . A reader read intermingled Beijing and Framingham Study films to ensure high reliability . We defined a subject as having radiographic knee OA when the Kellgren/Lawrence grade was > or = 2 in at least 1 knee . Symptomatic knee OA was recorded as present when knee pain was reported and the symptomatic knee had radiographic OA . We estimated the prevalence of these entities in elderly subjects in Beijing and compared it with OA prevalence in Framingham , using an age-st and ardized prevalence ratio . RESULTS Of 2,180 age-eligible Beijing subjects contacted , knee radiographs  were obtained in 1,787 ( 82.0 % ) . The prevalence of radiographic knee OA was 42.8 % in women and 21.5 % in men . Symptomatic knee OA occurred in 15.0 % of women and 5.6 % of men . Compared with women of the same age in Framingham , women in Beijing had a higher prevalence of radiographic knee OA ( prevalence ratio 1.45 , 95 % confidence interval 1.31 - 1.60 ) and of symptomatic knee OA ( prevalence ratio 1.43 , 95 % confidence interval 1.16 - 1.75 ) . The prevalence of knee OA in Chinese men was similar to that in their white US counterparts ( for radiographic OA , prevalence ratio 0.90 ; for symptomatic OA , prevalence ratio 1.02 ) . CONCLUSION Using identical methods and definitions to evaluate the prevalence of OA across population s , we found , surprisingly , that older Chinese women have a higher prevalence of knee OA than women in Framingham , Massachusetts . The prevalence in men was comparable . Possible explanations for these differences range from genetic differences to heavy physical activity among Chinese Abstract Although exercise is often recommended for managing osteoarthritis ( OA ) , limited evidence -based exercise options are available for older adults with OA . This study compared the effects of Hatha yoga ( HY ) and aerobic/strengthening exercises ( ASE ) on knee OA . R and omized controlled trial with three arms design was used : HY , ASE , and education control . Both HY and ASE groups involved 8 weekly 45-min group classes with 2–4 days/week home practice sessions . Control group received OA education brochures and weekly phone calls from study staff . St and ardized instruments were used to measure OA symptoms , physical function , mood , spiritual health , fear of falling , and quality of life at baseline , 4 and 8 weeks . HY/ASE adherences were assessed weekly using class attendance records and home practice video recordings . Primary analysis of the difference in the change from baseline was based on intent-to-treat and adjusted for baseline values . Eight-three adults with symptomatic knee OA completed the study ( 84 % female ; mean age 71.6 ± 8.0 years ; mean BMI 29.0 ± 7.0 kg/m2 ) . Retention rate was 82 % . Compared to the ASE group at 8 weeks , participants in the HY group had a significant improvement from baseline in perception of OA symptoms ( −9.6 [ 95 % CI −15.3 , −4 ] ; p = .001 ) , anxiety ( −1.4 [ 95 % CI −2.7 , −0 ] ; p = .04 ) , and fear of falling ( −4.6 [ −7.5 , −1.7 ] ; p = .002 ) . There were no differences in class/home practice adherence  between HY and ASE . Three non-serious adverse events were reported from the ASE group . Both HY and ASE  improved symptoms and function but HY may have superior benefits for older adults with knee OA . Trial registration The full trial protocol is available at clinical trials.gov ( NCT02525341 ) BACKGROUND Exercise programs improve balance , strength and agility in elderly people and thus may prevent falls . However , specific exercise programs that might be widely used in the community and that might be " prescribed " by physicians , especially for patients with osteoporosis , have not been evaluated . We conducted a r and omized controlled trial of such a program design ed specifically for women with osteoporosis . METHODS We identified women 65 to 75 years of age in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry in our hospital between 1996 and 2000 and who were not engaged in regular weekly programs of moderate or hard exercise .  Women who agreed to participate were r and omly assigned to participate in a twice-weekly exercise class or to not participate in the class . We measured baseline data and , 20 weeks later , changes in static balance ( by dynamic posturography ) , dynamic balance ( by a timed figure-eight run ) and knee extension strength ( by dynamometry ) . RESULTS Of 93 women who began the trial , 80 completed it . Before adjustment for covariates , the intervention group tended to have greater , although nonsignificant , improvements in static balance ( mean difference 4.8 % , 95 % confidence interval [ CI ] -1.3 % to 11.0 % ) , dynamic balance ( mean difference 3.3 % , 95 % CI -1.7 % to 8.4 % ) and knee extension strength ( mean difference 7.8 % , 95 % CI -5.4 % to 21.0 % ) . Mean crude changes in the static balance score were -0.85 ( 95 % CI -2.91 to 1.21 ) for the control group and 1.40 ( 95 % CI -0.66 to 3.46 ) for the intervention group . Mean crude changes in figure-eight velocity ( dynamic balance ) were 0.08 ( 95 % CI 0.02 to 0.14 ) m/s for the control group and 0.14 ( 95 % CI 0.08 to 0.20 ) m/s for the intervention group . For knee extension strength , mean changes were -0.58 ( 95 % CI -3.02 to 1.81 ) kg/m for the control group and 1.03 ( 95 % CI -1.31 to 3.34 ) kg/m for the intervention group . After adjustment for age , physical activity and years of estrogen use , the improvement in dynamic balance was 4.9 % greater for the intervention group than for the control group ( p = 0.044 ) . After adjustment for physical activity , cognitive status and number of fractures ever , the improvement in knee extension strength was 12.8 % greater for the intervention group than for the control group ( p = 0.047 ) . The intervention group also had a 6.3 % greater improvement in static balance after adjustment for rheumatoid arthritis and osteoarthritis , but this difference was not significant ( p = 0.06 ) . INTERPRETATION Relative to controls , participants in the exercise program experienced improvements in dynamic balance and strength , both important determinants of risk for falls , particularly in older women with osteoporosis Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA
CONCLUSION strength training , Tai Chi and aerobics exercises  improved balance and falls risk in older individuals with knee OA , while water-based exercises and light treatment did not significantly improve balance outcomes .
Strength training , Tai Chi and aerobics exercises can therefore be recommended as falls prevention strategies for individuals with OA .
INTRODUCTION osteoarthritis ( OA ) of knee has been reported as a risk factor for falls and reduced  balance in the elderly .
This systematic review evaluated the effectiveness of physical therapies in improving balance and reducing falls risk among patients with knee OA .