Platform Exercise Training
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The purpose of this randomized, controlled trial is to determine whether a vibration platform
      exercise program will be more effective than a standard platform exercise program in
      improving quadriceps strength in women age 45-60 who have risk factors for knee
      osteoarthritis. Each platform exercise program will be conducted 2 times a week for 12 weeks.
      The sessions will consist of a series of exercises on a Wave Pro-elite vibration platform
      (with 1-3 minute rests between sets) and stretches with the platform vibration either turned
      on (intervention group) or off (control group.) Quadriceps strength (primary outcome), leg
      press power, and vibration sense will be assessed at baseline and 12 weeks, and changed
      scores will be compared between groups.
    

Detailed description: 
      Osteoarthritis (OA) is the most common disabling disease in older adults,(1) affecting over
      25 million Americans, resulting in significantly impaired function and mobility(2) and a
      societal economic burden.(3) The knee is the weight-bearing joint most commonly affected,(10)
      and the prevalence of symptomatic knee OA is between 9% and 21% among those 65 years and
      older.(2, 11, 21) Loss of knee range of motion can lead to significant difficulty in bathing,
      lower body dressing, stair mobility, and walking.

      Impaired mobility due to knee OA will have an increasingly significant societal impact, with
      67 million adults projected to have arthritis by 2030, and 25 million with
      arthritis-attributable activity limitations.(22) Women are at greater risk for knee OA
      compared with men. Knee OA leads to chronic disability,(23-25) functional limitations,(26)
      and dependence.(27) Patients with knee OA frequently are limited in their activities by joint
      stiffness or buckling, decreased range of motion, muscle weakness, poor balance, impaired
      proprioception, reduced vibration sense, and/or pain. Currently, there are limited options
      available for patients for improving the outcome of knee OA once they have it. At this time,
      patients may use analgesics for pain with total knee replacement as the last option. However,
      we recently found that greater quadriceps strength protected against the development of
      incident symptomatic knee OA and progression of knee OA in women.(19-20) Thus, strengthening
      the quadriceps muscle may prevent worsening of the knee joint. Though before studying whether
      strengthening is effective in reducing risk for knee OA, it is necessary to first determine
      an effective and tolerated means of exercise.

      Vibration platform exercise may provide the benefits of strength training without adding
      potentially harmful loads to the knee joint. In one study of nursing home residents with
      limited functional capacity, balance and mobility improved over a 6-week whole body vibration
      exercise program. (12) In another study that compared whole body vibration (WBV) to
      resistance training in older women, greater improvement in knee extensor strength and speed
      of movement was found with WBV exercise.(13) Additionally, after a 2-month exercise program
      with older adults between the ages of 59 to 86, walking speed, step length, and the maximum
      standing time on one leg significantly improved with WBV exercise.(14) WBV exercise was safe
      and well tolerated in the elderly.(14, 15, 16) There have also been indications that WBV may
      improve flexibility. While a study testing range of motion (ROM) found that both the WBV and
      the control groups had significant increases in hamstring flexibility, only the WBV group
      showed a significantly larger increase (30%) in ROM than did the control group (14%).(17)
      There have also been indications WBV may improve proprioception (joint position sense) in
      women with knee osteoarthritis. One study which compared control versus exercise on a
      vibration platform and a balance board vibration platform found improvements in muscle
      strength and proprioception, respectively.(18) Thus, these studies suggest a beneficial
      effect of WBV exercise in addition to muscle strengthening, balance, and walking exercises in
      improving the walking ability in the elderly.

      Exercises conducted on a vibrating platform will induce a muscle reflex, increasing muscle
      fiber activation at a higher level compared to performing the exercises on a non-vibrating
      platform. We have selected the frequency and duration of this program based on 1) frequency
      used in previous studies and recommended by the manufacturer and 2) duration of 12 weeks
      based on previous data which found the most gain in knee extensor strength and speed of the
      movement occurred at week 12 of a 24-week program. (13)

      Vibration exercise may be a better option than strength training alone, if the exercises can
      be completed in less time and with similar strength gains as resistance training, but without
      the additional loads contributing to the stress on patients' joints.
    

Intervention name(s): Whole Body Vibration Training; Exercise without vibration
Intervention type(s): Other; Other
Intervention description(s): The subjects will participate in a 12-week exercise program with two sessions (1/2 hour) per week.; Participants will complete the same exercises without vibration twice a week for 12 weeks (1/2 hour sessions).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: osteoarthritis; whole body vibration; mobility; rehabilitation