An Innovative Mind-motor Exercise Approach to Osteoarthritis Treatment
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      Osteoarthritis (OA) is a growing burden in an aging society. There are few proven treatments
      and hence disability contributes to poor quality of life and direct/indirect costs to
      society. OA symptoms include both increased pain and reduced mobility. Strength training and
      aerobic exercise has been shown to improve symptoms in OA; however, the impact of targeted
      mobility and balance training in patients with osteoarthritis is unclear. The investigators
      propose a novel, low-impact exercise modality that improves balance and gait. The results of
      this research project should improve patient options and improve knowledge in OA management.
    

Detailed description: 
      Patients with OA have increased fall risk, which can lead to reduced mobility and curtailment
      of daily activities. Patients with OA also show varied and altered mobility in a sit-to-stand
      test, suggesting that both poor lower limb strength and flexibility need to be addressed with
      targeted interventions in this population. Altered mobility is also associated with pain in
      patients with OA. The cause of decreased mobility and increased pain is often a result of
      body weight. In a 5-year follow-up study, classes of knee OA were identified as being
      associated with good, moderate or poor outcomes; characteristics of the poor outcomes class
      included high BMI, worse pain, >2 co-morbidities and avoidance of activities. Avoidance of
      activities is a particularly important outcome since this could lead to a downward spiral of
      decreased physical functioning, falls and further avoidance of activities.

      Multiple studies have shown that increasing weight from normal to overweight or obese
      decreases mobility and increases pain in individuals with OA. This is a potential target for
      non-pharmacological therapies. For example, Messier et al., showed that a diet and exercise
      intervention designed to promote weight loss in overweight individuals with knee OA, improved
      knee compressive forces and function, reduced inflammatory marker IL-6, decreased pain and
      improved physical health-related quality of life over an 18-month period. This study
      demonstrated the important effects of weight loss and exercise on knee OA for overall health.
      In a recent review, the evidence was overwhelming regarding the use of exercise as a
      treatment of knee OA. Specifically, the literature demonstrates that strength training and
      aerobic exercise can improve outcomes, such as pain reduction and increased function, in
      patients with OA. Lifestyle interventions should be utilized in OA populations to help reduce
      pain, improve mobility and reduce fall risk.

      Square-Stepping Exercise (SSE) was developed is a low-tech, low-intensity, novel form of
      exercise developed in Japan. SSE was originally designed to reduce fall risk in older adults.
      Participants watch, recognize, memorize and follow increasingly more difficult step patterns,
      which an instructor demonstrates on a 4 by 10 square-patterned mat. In older adult
      populations, Shigematsu and colleagues have found that SSE improves overall fitness and lower
      extremity functioning, as well as reduces fall risk, when compared to walking programs or
      strength and balance training. In combination with Shigematsu's research in Japan in healthy
      older adults, the investigators are aiming to provide a significant evidence base for SSE
      internationally and within varied populations, including older adults with osteoarthritis. In
      collaboration with Dr. Shigematsu, the investigators have executed SSE studies at the
      Canadian Centre for Activity and Aging in London, ON and most recently in Woodstock, ON.
      Preliminary evidence from our study at the Canadian Centre for Activity and Aging showed that
      over a 3-month training period, participants in our Exercise-Intervention (E-I) group
      (involving mind-motor exercise) improved their total balance scores, compared to an
      Exercise-Control (E-C) group.

      SSE has not been tested in the OA population. This pilot study will add to the literature to
      determine whether it reduces pain and improves mobility as an additional non-pharmacological
      treatment for this population.
    

Intervention name(s): Square-stepping exercise
Intervention type(s): Behavioral
Intervention description(s): Participants are asked to remember and repeat stepping patterns across a gridded mat as shown to them by an instructor.
Other intervention name(s): Mind-motor exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment