Comparing the Effects of Upper and Lower Body Aerobic Exercise on Pain in Individuals With Chronic Knee Pain

Study Overview
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Brief Summary
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The investigators want to compare the effects of upper versus lower body moderate aerobic exercise on the experience of pain in individuals with chronic knee pain. Participants will attend the laboratory on 4 separate occasions to complete a series of exercise tests and experimental pain tests.

Detailed Description
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Pain has a multifaceted nature encompassing peripheral drivers (i.e. loading), peripheral and central nervous systems (peripheral and central sensitisation) and cognition (i.e. fear). Most recently, evidence supports that chronic pain in OA may cause alterations to the peripheral and central nervous systems. Despite this, current research has mainly targeted peripheral drivers (usually weight reduction) and cognition (educational programmes) with results highlighting that such methods are not always effective in reducing pain. It would be useful to provide a wider range of choice when prescribing exercise for OA for those which the current prescription is ineffective or un-desirable. Acutely, both localised and generalised exercise involving the knee joint in individuals with KOA is known to increase symptomatic pain in some. However, research suggests that diverting exercise away from the affected joint may improve pain perception and pain experience in a subset of individuals by targeting cognition (attention away from the joint) and alleviating peripheral drivers of pain (reduced loading) while still presenting systemic physiological benefits that come with acute aerobic exercise which target peripheral and central sensitisation. Currently, there is only one study (Burrows et al, 2014) which has compared the effects of acute upper vs. lower body exercise on pain perception in KOA patients and this was employing resistance exercise. Although this study found positive effects of upper body exercise on pain, this pain was experimentally induced, and symptomatic pain was not measured. The investigators aim is to determine the effects of a single bout of upper body aerobic exercise on experimentally induced and symptomatic pain in individuals with chronic knee pain in comparison with lower body aerobic exercise.

Official Title
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A Comparison of the Effects of Upper Versus Lower Body Aerobic Exercise on the Experience of Pain in Individuals With Chronic Knee Pain

Conditions
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Chronic Knee Pain

Intervention / Treatment
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* Other: Upper body aerobic exercise
* Other: Lower body aerobic exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged ≥45 years Male or female Knee pain for ≥3 months Activity related joint pain No joint related morning stiffness, or morning stiffness lasting less than 30 minutes. Exclusion Criteria: Specific joint injury within the last 6 months Inability to undertake cycling exercise Use of anti-inflammatory medication Smoker (or having quit <6 months ago) Osteoarthritis at any upper body sites that would affect ability to complete arm-cycling exercise.

Ages Eligible for Study
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Minimum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Upper Body Aerobic Exercise<br>Participants will perform 30 minutes of arm-crank cycling at a moderate exercise intensity based off the participants perceived RPE13 | Other: Upper body aerobic exercise<br>* Participants will perform 30 minutes of continuous exercise on the arm-crank ergometer.<br>|
| Experimental: Lower Body Aerobic Exercise<br>Participants will perform 30 minutes of static cycling at a moderate exercise intensity based off the participants perceived RPE13 | Other: Lower body aerobic exercise<br>* Participants will perform 30 minutes of continuous exercise on the cycle ergometer.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute Symptomatic Pain | Change in symptomatic pain measured via Visual Analogue Scale (VAS) from pre- to post-exercise on a 0-10 scale where 0 is no pain at all and 10 is the worst pain imaginable | Immediately pre and immediately-post exercise | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute Experimental Pain | Change in experimental pain via Pressure pain threshold and Mechanical detection threshold from pre- to post- exercise | Immediately pre and immediately-post exercise | 
| Follow up Symptomatic Pain | Average symptomatic pain in the 7 days following each trial visit measured on a 0-10 Visual Analogue Scale (VAS) where 0 indicates no pain at all and 10 indicates worst pain imaginable | 1-7 days post exercise |