Do Obese Patients With Primary Knee Osteoarthritis Benefit From a Single Bout of Moderate Intensity Aerobic Exercise?
Condition: Knee Osteoarthriis and Oxidative Stress
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Observational

Summary: 
      Background: Obesity and degenerative joint disease are typically concomitant . Each are in
      the course of aerobic focus and excited inflammatory response. Exercise is taken into account
      a considerable treatment in rehabilitation of each conditions. nevertheless most of
      literature reported the good thing about regular exercise, whereas there's dearth regarding
      the consequence of base hit low to centrist usage session .

      Objective:Hence, this report aimed to analyze the attainable effects of a single bout of
      moderate excercise in obese patients with KOA.

      Methods:Thirty four rotund OA untrained semantic role and thirty age and sex matched healthy
      controls were registered during this sketch . OA patients were allotted to single session of
      low to moderate exercise on treadmill whereas controls remained unexercised. Perceived pain,
      GR activity, IL-6 , CRP, fasting blood glucose and lipid profile were assessed at baseline ,
      once exercise and 24h after. Meanwhile, WOMAC score determined at baseline and once 24h.
    

Detailed description: 
      Study population:

      This is an observational study a cohort of sedentary Egyptian patients included thirty four
      obese patients role diagnosed with primary human knee joint OA according to the criteria of
      the American College of Rheumatology (ACR)( 8).were selected from those attending the
      outpatient clinics of Rheumatology and Rehabilitation Department , Mansoura University (28
      females and 6 males; mean age, 46.94 ± 10.84 years; trunk mass index, 40.91 ± 10.09 kg/m2).
      In addition, 30 healthy volunteers with no clinical and radiological evidence of OA(22
      females and8 males; mean age,50.7 ±10.5 ; BMI 24.3±1.3)participated in the discipline .

      Inclusion criteria: knee OA with obesity; sedentary with no previous education ; ability to
      understand and follow commands; and ability to walk independently.

      Exclusion criteria: Medical conditions contraindicating moderate aerobic exercising (as
      determined through prescreening questions, i.e., cardiac or coronary artery disease as
      ischemic cardiomyopathy , chronic lung disease, asthma, uncontrolled hypertension), inability
      to exercise via treadmill(i.e. no neuromuscular or lower extremity conditions or any other
      medical contraindication that could prevent them from floor walking as upset affecting
      movement of the pelvic arch or pace , story of previous hip or knee operating room
      ,periarticular fractures, or lower limb injuries).History of recent reefer transmission or
      acute joint lighting .History of recent joint injection (steroid, hyaluronic acid , etc.)
      within 6 calendar week of study. Ingestion of antioxidant supplementation and the use of
      psychotropic agents.

      Participants underwent bilateral AP standing x ray to verify the presence and degree of human
      knee OA. X-rays were marked exploitation the Kellgren and Lawrence (K/L) scale for knee OA
      severity(9).Subjects with picture taking knee OA of KL grade ≥2 in a minimum of one knee were
      listed. The grading of the worst affected knee in every patient was used for knowledge
      analysis.

      Physical examinations including age and body mass index (BMI) were obtained at the same
      visits at which radiographs were obtained. Western Ontario and McMaster Universities
      Arthritis Index (WOMAC) scores of the OA patients were collected (10).

      Treadmill Training Protocol

      Each eligible participant in the patients group was then prospectively assigned to undergo
      exercise session of full-body-free weight treadmill training. Once the participants were
      prepped, they performed stretching for 5 min and slow walking for 3 min as a warm-up exercise
      before starting the training. Stretch was carried out similarly to all the subjects to
      quadriceps femoris and the hamstring. In the warm-up time period , it was enforced for 3 min
      at the speed of1 km/h. Then patients began the walking trials and walked at 1 to 1.34 m/s on
      an electric car treadmill (JACO fitness: JACO-212C).

      Exercise intensity

      For the purpose of this study, Metabolic Equivalents (METs) and Rate of Perceived Exertion
      (RPE) were used as guidelines to determine exercise intensity. Moderate aerobic exercise has
      been objectively defined as activity that generates energy expenditure of 3.0 to 6.0 (METs)
      (11).

      To determine the intensity, time and frequency of exercise, it was set at low to moderate,
      that is between 40% and 60% of the maximum heart rate, from 12 to 14 rating of RPE. In
      addition, each subject was shown the 15 point Borg Rating of Perceived Exertion scale and
      instructed in its use. The RPE scale was mounted on the wall in front of the treadmill and
      easily visible to the subjects. Exercise instructions and measurements of associated
      Metabolic Equivalents (METs) were determined based upon previous studies which determined
      that walking on a level surface at 3.0 MPH equates to 3.3 METs and walking at 4.5 MPH
      generates 6.3 METs(12).

      Participants walked at a pace of 2.5 to 3.0 MPH on a treadmill with zero incline for 30 min
      and they were instructed to walk at a pace that neither caused pain nor increased symptoms
      (13).

      To minimize pain that may occur due to treadmill exercise, 5 min rest were allowed after 15
      min of exercise. In the control group, the subjects remained at rest.

      The present study was conducted in agreement with the guidelines of the Declaration of
      Helsinki. Written informed consent was received from every patient and healthy subject before
      participating in the study. This study was approved by the Institutional Research Board of
      the Faculty of Medicine, Mansoura University code R.18.04.137

      Laboratory assays:

      Blood samples were drawn before and once exercise (within 0.5 h once exercise,and at 24 h).
      All organic chemistry measurements were performed on frozen plasma samples obtained by
      activity of freshly drawn blood (3000 × g for 20minutes at 4∘C) and consequent storage at
      -70∘C. Blood macromolecule profiles, together with total cholesterol (TC), HDL cholesterol
      (HDL-C), calculated LDL cholesterol(LDL-C), and triglycerides (TG) concentrations were
      determined by protein assays., further as abstinence blood sugar level.

      IL-6, CRP Serum concentrations of IL-6 were determined using sandwich high sensitivity ELISA
      kit for quantitative detection of human IL-6 according to manufacturer's protocol (Boster
      Immunoleader by Boster Biological Technology Co. Inc.). Detection of serum CRP was performed
      by Solid Phase Sandwich ELISA according to manufacturer's instructions (Quantikine Human CRP
      Immunoassay, R&D systems)

      Glutathione reductase assay:

      Spectrophotometric determination of GR activity in the serum was measured as described by
      Calberg and Mannervic (14) using commercially available Glutathione Reductase Assay Kit(Sigma
      chemical company, St Louis, Missouri, USA). Glutathione reductase catalyzes the reduction of
      GSSG by oxidizing NADPH to NADP+. The decrease in absorbance was measured at 340.
    

Intervention name(s): pre and post excercise group
Intervention type(s): Diagnostic Test
Intervention description(s): Treadmill Training Protocol
Each eligible participant in the patients group was then prospectively assigned to undergo exercise session of full-body-free weight treadmill training. Once the participants were prepped, they performed stretching for 5 min and slow walking for 3 min as a warm-up exercise before starting the training. Stretch was carried out similarly to all the subjects to quadriceps femoris and the hamstring. In the warm-up time period , it was enforced for 3 min at the speed of1 km/h. Then patients began the walking trials and walked at 1 to 1.34 m/s on an electric car treadmill (JACO fitness: JACO-212C).
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        a cohort of egyptian patients suffering from obesity and knee osteoarthritis
      
Keywords: Osteoarthritis- Obesity- single aerobic exercise session