Abstract
BackgroundSymptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis.MethodsA minimum of 80 volunteers who meet the inclusion criteria will be recruited from the local population through newspaper advertisements. Following initial assessment volunteers will be randomised into two groups. The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3 times a week for four months. The control group will be asked to maintain normal care during this period. Primary outcome measure for this study is the biochemical composition of knee cartilage measured using quantitative magnetic resonance imaging; T2 relaxation time and delayed gadolinium-enhanced magnetic resonance imaging techniques. In addition, knee cartilage morphology as regional cartilage thickness will be studied. Secondary outcomes include measures of body composition and bone traits using dual energy x-ray absorptiometry and peripheral quantitative computed tomography, pain, function using questionnaires and physical performance tests and quality of life. Measurements will be performed at baseline, after the 4-month intervention period and at one year follow up.DiscussionThis randomised controlled trial will investigate the effect a progressive aquatic resistance exercise program has on the biochemical composition of cartilage in post-menopausal women with mild knee osteoarthritis. This is the first study to investigate what impact aquatic exercise has on human articular cartilage. In addition it will investigate the effect aquatic exercise has on physical function, pain, bone and body composition and quality of life. The results of this study will help optimise the prescription of aquatic exercise to persons with mild knee osteoarthritis.Trial RegistrationISRCTN65346593
Highlights
Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs
This paper describes the rationale and design of a randomised control trial investigating the effect a progressive aquatic resistance training program will have on patellofemoral and tibiofemoral cartilage, properties of bone and body composition and physical function in post-menopausal women with mild knee osteoarthritis
Exercise is one of the main non-pharmaceutical treatments recommended in the management of lower limb OA [24,25,26,28,29]
Summary
Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. As the disease progresses there is fibrillation of the cartilage, changes in the subchondral bone, formation of osteophytes and thickening of the synovium [8,9,10,11] and as such OA is considered a whole joint disease These modifications within the joint lead to the gradual development of clinical symptoms such as stiffness, decreased range of motion and pain [12] which cause a decrease in joint proprioception [13] and inhibits muscle activation [14,15] leading to a decrease in activity. Reduced muscle strength is a risk factor for future pain [17], self-reported knee instability [18] and increased risk of falling [19]
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