Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA) and whether these improvements were related to adherence. METHODS: We searched six databases, from inception to January 28, 2023, for randomized controlled trials comparing land-based, resistance exercise-only interventions with no intervention, or any other intervention. There were four subgroups of intervention duration: 0 to <3 months, 3 to 6 months, >6 to <12 months, ≥12 months. The between-group effect was calculated for immediate postintervention pain and physical function (activities of daily living [ADL] and sports/recreation [SPORT]). RESULTS: For both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL, and physical function SPORT in favor of interventions 3 to 6 months. For the knee, there was also a moderate benefit for physical function ADL in favor of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. A total of 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function. CONCLUSION: In knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose.

Muscle Architecture and Subcutaneous Fat Measurements of Rectus Femoris and Vastus Lateralis at Optimal Length Aided by a Novel Ultrasound Transducer Attachment.

Purpose: This cross-sectional study determines the sensitivity of muscle architecture and fat measurements of the rectus femoris (RF) and vastus lateralis (VL) muscles from ultrasound images acquired with varying transducer tilt, using a novel transducer attachment, in healthy adults. Secondary objectives were to estimate intrarater and interrater reliability of image measurement and acquisition, respectively. Methods: Thirty healthy adults participated (15 women and 15 men; 25 [SD 2.5] y). Ultrasound image acquisition was conducted by two raters at different transducer tilts relative to the skin: estimated perpendicular, and five measured angles (80°, 85°, 90°, 95°, 100°) using the transducer attachment. Muscle thickness (MT), subcutaneous fat thickness (FT), pennation angle (PA), and fascicle length (FL) were measured. Sensitivity and reliability were assessed using intra-class correlation coefficients (ICCs) and standard error of measurements (SEMs). Results: MT and FT for RF and VL were not sensitive to transducer tilt. However, PA and FL were sensitive to transducer tilt. MT and FT for both muscles showed high ICCs and low SEMs for intrarater and interrater reliability. For PA of both muscles, standardizing transducer tilt improved interrater ICCs and lowered SEMs. Conclusion: MT and FT measurements of RF and VL acquired at 60° knee flexion are robust to varying transducer tilt angles. PA measurements benefit from standardizing transducer tilt.

Objectif : étude transversale pour déterminer la sensibilité de l'architecture musculaire et des mesures lipidiques du muscle droit antérieur de la cuisse (MDAC) et du muscle vaste externe (MVE) à partir des images échographiques acquises chez des adultes en santé par diverses inclinaisons du transducteur, au moyen d'un nouveau dispositif. Les objectifs secondaires consistaient à évaluer la fiabilité intraévaluateurs et interévaluateurs des mesures et de l'acquisition des images, respectivement. Méthodologie: au total, 30 adultes en santé ont participé (15 femmes et 15 hommes de 25 [ÉT 2,5 ans]). Deux évaluateurs ont acquis des images échographiques à des inclinaisons différentes du transducteur par rapport à la peau : mesure perpendiculaire estimative et mesure à cinq angles (80°, 85°, 90°, 95°, 100°) au moyen du dispositif du transducteur. Ils ont mesuré l'épaisseur des muscles (ÉM), l'épaisseur de la graisse sous-cutanée (ÉG), l'angle de pennation (AP) et la longueur des fascicules (LF). Ils ont aussi évalué la sensibilité et la fiabilité au moyen de coefficients de corrélation intraclasse (CCI) et de l'écart-type des mesures (ÉTM). Résultats: l'ÉM et l'ÉG du MDAC et du MVE n'étaient pas sensibles à l'inclinaison du transducteur, mais l'AP et la LF l'étaient. La fiabilité intraévaluateur et interévaluateur de l'ÉM et de l'ÉG des deux muscles présentait un CCI élevé et un ÉTM faible. Pour ce qui est de l'AP des deux muscles, la standardisation de l'inclinaison du transducteur améliorait la CCI et réduisait l'ÉTM interévaluateurs. Conclusion: les mesures de l'ÉM et de l'ÉG du MDAC et du MVE acquises à une flexion du genou de 60° sont probantes à des angles d'inclinaison variables du transducteur. Les mesures de l'AP tirent profit d'une inclinaison du transducteur standardisée.

Nutrition risk, physical activity and fibre intake are associated with body composition in OA: analysis of the Canadian Longitudinal Study on Aging.

Objective: Sarcopenic obesity is a key feature in osteoarthritis (OA). While ideal OA treatment involves physical activity and diet, how diet influences OA pathophysiology is unclear. We explored the associations between diet, nutrition risk and physical activity with body composition in older adults with OA. Methods: Baseline data from the Canadian Longitudinal Study on Aging data set were analysed. Participants with hip, knee, hand or multiple forms of OA were included in this cross-sectional analysis. Body composition measures (lean, fat and total masses (kg) and body fat percentage) were separate dependent variables. Regression analyses were conducted to explore associations between body composition with dietary intake (high calorie snack, fibre), nutrition risk (SCREEN II) and physical activity (Physical Activity Scale for the Elderly). Results: 1596 participants were 66.5 (9.0) years old with a body mass index of 28.2 (5.3) kg/m2. Higher fibre cereal intake was associated with higher lean mass (unstandardised beta coefficient 0.5 (0.1, 0.9), p=0.02) and lower body fat percentage (-0.3 (-0.6, 0.0), p=0.046). Lower nutrition risk was associated with higher lean mass (0.1 (0.0, 0.1), p=0.03), lower fat mass (-0.05 (-0.1, 0.0), p=0.009) and lower body fat percentage (-0.1 (-0.1, 0.0), p<0.001). Higher physical activity was associated with higher lean mass (0.01 (0.01, 0.02), p<0.001), lower fat mass (-0.01 (0.0, 0.0), p=0.005) and lower body fat percentage (-0.01 (0.0, 0.0), p<0.001). Conclusion: Greater physical activity and lower nutrition risk were associated with better body composition. While fibre intake was also associated body composition, the CIs were wide suggesting weak associations.

Muscle strength gains after strengthening exercise explained by reductions in serum inflammation in women with knee osteoarthritis.

Background Individuals with knee osteoarthritis have elevated circulating inflammatory markers and altered cartilage properties but it is unclear if these features adapt to exercise. We aimed to determine (1) whether inflammatory markers, cartilage transverse relaxation time and thickness mediate the effect of body mass index (BMI) on quadriceps strength at baseline; and (2) whether these changes explain variance in quadriceps strength improvements after 12 weeks of exercise in women with knee osteoarthritis. Methods This secondary analysis (17 women with clinical knee osteoarthritis) of a randomized control trial compared supervised group interventions, 3 times/week for 12 weeks (36 sessions): (a) weight-bearing progressive resistive quadriceps exercise or (b) attention control. (1) From baseline, separate linear regressions were conducted with strength (Nm/kg) as the dependent, BMI as the predictor, and c-reactive protein, tumor necrosis factor, interleukin-6, cartilage transverse relaxation time or thickness as potential mediators. (2) Multiple linear regression analyses were completed with 12-week strength change (post-pre) as the dependent, change in serum inflammatory markers and cartilage measurements as predictors, and age, BMI and adherence as covariates. Findings (1) At baseline, there was no mediation. (2) A decrease in each of interleukin-6 (ß = -0.104 (95% confidence intervals: -0.172, -0.036), R2 = 0.51, P < 0.007) and tumor necrosis factor (ß = -0.024 (-0.038, -0.009), R2 = 0.54, P < 0.005) was associated with strength gains. Interpretation At baseline, inflammatory markers and cartilage measurements do not act as mediators of BMI on quadriceps strength. After 12 weeks of exercise, reduced interleukin-6 and tumor necrosis factor were associated with increased quadriceps strength in women with knee osteoarthritis.

Evaluating the relationship between quadriceps muscle quality captured using ultrasound with clinical severity in women with knee osteoarthritis.

BACKGROUND: Infiltration of muscle with non-lean tissue, such as fat, reduces muscle quality. Ultrasound captures muscle quality through measurement of echogenicity. Given the potential implications of quadriceps muscle quality on physical function, particularly in knee osteoarthritis, the purpose of this study was to investigate the relationship between echogenicity, muscle thickness and subcutaneous fat thickness with the clinical severity of osteoarthritis. METHODS: Thirty-one women with clinical knee osteoarthritis participated. Rectus femoris and vastus lateralis echogenicity, muscle thickness and subcutaneous fat thickness were measured from ultrasound images of the most symptomatic knee. Clinical severity of osteoarthritis was characterized with pain, self-reported function, six-minute walk test, and knee extensor strength. Correlation coefficients were calculated between muscle and fat architecture outcomes (muscle quality, muscle and fat thicknesses) and osteoarthritis clinical severity outcomes. FINDINGS: Data from 25 women were of sufficient quality for analysis. Echogenicity (muscle quality) related to the six-minute walk test for both rectus femoris (r = -0.52, p = 0.02) and vastus lateralis (r = -0.74, p = 0.004), with poorer muscle quality related to lower mobility. Subcutaneous fat thickness was related to the six-minute walk test (rectus femoris, r = -0.61, p = 0.0012; vastus lateralis, r = -0.73, p = 0.003) and strength (rectus femoris, r = -0.46, p = 0.02; vastus lateralis, r = -0.59, p = 0.03). Muscle thickness was not related to any severity outcomes. INTERPRETATION: Muscle quality, rather than thickness, is associated with mobility performance in women with knee osteoarthritis. Thus, interventions for osteoarthritis that specifically target muscle quality, rather than size, should be explored.

Diet and Nutrition Risk Affect Mobility and General Health in Osteoarthritis: Data from the Canadian Longitudinal Study on Aging.

BACKGROUND: This study examined whether aspects of diet and nutrition risk explain variance in physical capacity and general health, after controlling for covariates, in Canadian adults with osteoarthritis (OA). METHODS: This was a cross-sectional study of baseline data from the Canadian Longitudinal Study on Aging (CLSA). Data from 1,404 participants with hand, hip, and/or knee OA were included. A series of regression analyses were conducted with independent variables of food intake (fiber and high calorie snack intake) and nutrition risk; and dependent variables of physical capacity and general health. Physical capacity was characterized through grip strength and a pooled index of four mobility tests. General health was characterized through an index of self-reported general health, mental health, and healthy aging. RESULTS: Higher fiber intake was related to greater mobility (p = .01). Food intake was not related to any other outcome. Nutrition risk was significantly associated with mobility (p < .001) and general health (p < .001); those with a high nutrition risk classification had poorer general health (p < .001, d = 0.65) than those at low nutrition risk. As well, those with moderate nutrition risk had poorer general health than those with low nutrition risk (p = .001, d = 0.31). CONCLUSIONS: Nutrition risk screening for older adults with OA provides insight into behavioral characteristics associated with reduced mobility and poorer general health. Also, those consuming greater amounts of fiber demonstrated better mobility. Thus, this research suggests that quality of diet and nutritional behaviors can impact both physical and mental aspects of health in those with OA.

Investigating the Test-Retest Reliability and Validity of Hand-Held Dynamometry for Measuring Knee Strength in Older Women with Knee Osteoarthritis.

Purpose: Hand-held dynamometry (HHD) can be used to evaluate strength when gold-standard isokinetic dynamometry (IKD) is not feasible. HHD is useful for measuring lower limb strength in a healthy population; however, its reliability and validity in individuals with knee osteoarthritis (OA) has received little attention. In this research, we examined the test-retest reliability and validity of HHD in older women with knee OA. We also examined the associations between reliability and symptom and disease severity. Method: A total of 28 older women with knee OA completed knee extension and flexion exertions measured using HHD and IKD. Intra-class correlation coefficients (ICC2,3), standard error of measurement, and minimal detectable change were calculated. Correlation coefficients and regressions evaluated the relationships between inter-trial differences and symptom and disease severity. Results: High test-retest reliability was demonstrated for both exertions with each device (ICC2,3 = 0.83-0.96). Variance between trials was not correlated with OA symptoms. Criterion validity was good (ICC2,3 = 0.76), but extension yielded lower agreement than flexion. Regression analysis demonstrated that true strength can be predicted from HHD measurements. Conclusions: HHD is a reliable tool for capturing knee extension and flexion in individuals with OA. Because of lower agreement, HHD might be best suited for evaluating within-subject strength changes rather than true strength scores. However, gold-standard extension strength magnitudes may reasonably be predicted from regression equations (r 2 = 0.82).

Objectif : la dynamométrie portative (DP) peut évaluer la force lorsque la dynamométrie isocinétique (DIC) de référence n'est pas réalisable. La DP est utile pour mesurer la force des membres inférieurs dans une population en santé, mais on n'en a pas vraiment établi la fiabilité et la validité chez les personnes atteintes d'arthrose du genou. La présente étude a porté sur la fiabilité test­retest et la validité de la DP chez les femmes âgées atteintes d'arthrose du genou. Elle a également porté sur les associations entre la fiabilité et la gravité des symptômes et de la maladie. Méthodologie : au total, 28 femmes âgées atteintes d'arthrose du genou ont effectué des efforts d'extension et de flexion du genou, qui ont été mesurés par DP et DIC. Les chercheurs ont calculé les coefficients de corrélation intraclasse (CCI2,3), l'écart-type de mesure et le changement décelable minimal. Avec les coefficients de corrélation et la régression, ils ont évalué la relation entre les différences interessai et la gravité des symptômes et de la maladie. Résultats : les chercheurs ont démontré la haute fiabilité test­retest des deux appareils à l'effort (CCI2,3 = 0,83 à 0,96). L'écart entre les essais n'était pas corrélé avec les symptômes d'arthrose. Les critères avaient une bonne validité (CCI2,3 = 0,76), mais l'extension procurait une moins bonne concordance que la flexion. L'analyse de régression a démontré qu'il est possible de prédire la véritable force à l'aide des mesures de DP. Conclusion : la DP est un outil fiable pour mesurer l'extension et la flexion du genou chez les personnes atteintes d'arthrose. En raison de sa concordance plus faible, la DP convient peut-être mieux pour évaluer les changements de force intra-individuels plutôt que les véritables scores de force. Cependant, les équations de régression peuvent raisonnablement prédire l'amplitude de force de l'extension de référence (r 2 = 0,82).

The Effects of Lower Extremity Strengthening Delivered in the Workplace on Physical Function and Work-Related Outcomes Among Desk-Based Workers: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to assess the effectiveness of a workplace leg-strengthening program on self-reported function, physical capacity, and work-related outcomes among desk-based workers. METHODS: Forty-three desk-based workers were randomized to a 12-week exercise program or no exercise control. The primary outcome was change in self-reported physical function on the Lower Extremity Functional Scale (LEFS) from baseline to follow-up. Secondary outcomes were physical capacity (mobility, strength), self-reported outcomes (pain, depressive symptoms), and work-related outcomes (resilience, work ability). RESULTS: The exercise group showed greater improvements in LEFS and mobility. No significant between-group differences existed in knee strength or remaining self-reported and work-related outcomes. CONCLUSION: Workplace implemented leg-strengthening exercises are effective at improving self-reported and physical health outcomes of desk-based workers. Moving forward, occupational exercise interventions may be essential to enhance worker longevity among the aging, sedentary workforce.

Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial.

OBJECTIVE: Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis. DESIGN: Single-blind, three-arm randomized controlled trial. SETTING: Community in Southwestern Ontario, Canada. PARTICIPANTS: A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth. INTERVENTIONS: Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week. MEASUREMENTS: Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention. RESULTS: The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE. CONCLUSIONS: The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02370667).

Randomized Controlled Trial Investigating the Role of Exercise in the Workplace to Improve Work Ability, Performance, and Patient-Reported Symptoms Among Older Workers With Osteoarthritis.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a 12-week workplace exercise program on work ability, performance, and patient-reported symptoms in older university employees with knee and/or hip osteoarthritis. METHODS: Twenty-four participants with clinical hip and/or knee osteoarthritis were randomized to exercise or no exercise. At baseline and follow-up, several work (work ability, resilience), patient-reported (pain, physical function, depressive symptoms, self-efficacy), and performance outcomes (hip and knee strength, mobility performance) were measured. RESULTS: Significant improvements in work ability (P < 0.049) and patient-reported outcomes (pain, function, depressive symptoms) existed in the exercise group. No improvements were demonstrated in the no exercise group. CONCLUSIONS: Exercise in the workplace improved work ability and patient-reported symptoms in older workers with osteoarthritis. The benefits of workplace exercise programs should be studied in a larger sample in which attention is given to improving exercise adherence.

Baseline knee adduction moment interacts with body mass index to predict loss of medial tibial cartilage volume over 2.5 years in knee Osteoarthritis.

This study aimed to determine the extent to which changes over 2.5 years in medial knee cartilage thickness and volume were predicted by: (1) Peak values of the knee adduction (KAM) and flexion moments; and (2) KAM impulse and loading frequency, representing cumulative load, after controlling for age, sex and body mass index (BMI). Adults with clinical knee osteoarthritis participated. At baseline and approximately 2.5 years follow-up, cartilage thickness and volume of the medial tibia and femur were segmented from magnetic resonance imaging scans. Gait kinematics and kinetics, and daily knee loading frequency were also collected at baseline. Multiple linear regressions predicted changes in cartilage morphology from baseline gait mechanics. Data were collected from 52 participants (41 women) [age 61.0 (6.9) y; BMI 28.5 (5.7) kg/m2 ] over 2.56 (0.51) years. There were significant KAM peak-by-BMI (p = 0.023) and KAM impulse-by-BMI (p = 0.034) interactions, which revealed that larger joint loads in those with higher BMIs were associated with greater loss of medial tibial cartilage volume. In conclusion, with adjustments for age, sex, and cartilage measurement at baseline, large magnitude KAM peak and KAM impulse each interacted with BMI to predict loss of cartilage volume of the medial tibia over 2.5 years among individuals with knee osteoarthritis. These data suggest that, in clinical knee osteoarthritis, exposure to large KAMs may be detrimental to cartilage in those with larger BMIs. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2476-2483, 2017.

Does pain relate with activation of quadriceps and hamstrings muscles during strengthening exercise in people with knee osteoarthritis?

Muscle strengthening may be difficult to achieve in knee osteoarthritis (OA) due to pain. A large knee adduction moment (KAM), representing medial relative to lateral knee load, may also relate with pain during strengthening exercise. The objective of this study was to examine relationships between knee pain status and electromyography (EMG) amplitude of knee muscles during squat and lunge exercises. We also evaluated relationships between pain and KAM during these exercises. Forty-two women with symptomatic knee OA participated. Knee pain intensity and frequency were captured with two reliable and valid questionnaires. Motion analyses of squat and lunge exercises were completed. Total average EMG amplitude across five muscles of the lower limb and average KAM were calculated from the static portion of these exercises. Multiple regression analyses examined the relationships between pain and total average EMG amplitude; and pain and average KAM during squats and lunges. Pain improved the model for KAM from the trailing leg of a lunge. Pain did not improve any other model. Overall, pain may not be a useful indicator of EMG amplitude or KAM during exercise in knee OA.

A Yoga Strengthening Program Designed to Minimize the Knee Adduction Moment for Women with Knee Osteoarthritis: A Proof-Of-Principle Cohort Study.

UNLABELLED: People with knee osteoarthritis may benefit from exercise prescriptions that minimize knee loads in the frontal plane. The primary objective of this study was to determine whether a novel 12-week strengthening program designed to minimize exposure to the knee adduction moment (KAM) could improve symptoms and knee strength in women with symptomatic knee osteoarthritis. A secondary objective was to determine whether the program could improve mobility and fitness, and decrease peak KAM during gait. The tertiary objective was to evaluate the biomechanical characteristics of this yoga program. In particular, we compared the peak KAM during gait with that during yoga postures at baseline. We also compared lower limb normalized mean electromyography (EMG) amplitudes during yoga postures between baseline and follow-up. Primary measures included self-reported pain and physical function (Knee injury and Osteoarthritis Outcome Score) and knee strength (extensor and flexor torques). Secondary measures included mobility (six-minute walk, 30-second chair stand, stair climbing), fitness (submaximal cycle ergometer test), and clinical gait analysis using motion capture synchronized with electromyography and force measurement. Also, KAM and normalized mean EMG amplitudes were collected during yoga postures. Forty-five women over age 50 with symptomatic knee osteoarthritis, consistent with the American College of Rheumatology criteria, enrolled in our 12-week (3 sessions per week) program. Data from 38 were analyzed (six drop-outs; one lost to co-intervention). Participants experienced reduced pain (mean improvement 10.1­20.1 normalized to 100; p<0.001), increased knee extensor strength (mean improvement 0.01 Nm/kg; p = 0.004), and increased flexor strength (mean improvement 0.01 Nm/kg; p = 0.001) at follow-up compared to baseline. Participants improved mobility on the six-minute walk (mean improvement 37.7 m; p<0.001) and 30-second chair stand (mean improvement 1.3; p = 0.006) at follow-up compared to baseline. Fitness and peak KAM during gait were unchanged between baseline and follow-up. Average KAM during the yoga postures were lower than that of normal gait. Normalized mean EMG amplitudes during yoga postures were up to 31.0% of maximum but did not change between baseline and follow-up. In this cohort study, the yoga-based strengthening postures that elicit low KAMs improved knee symptoms and strength in women with knee OA following a 12 week program (3 sessions per week). The program also improved mobility, but did not improve fitness or reduce peak KAM during gait. The KAM during the yoga postures were lower than that of normal gait. Overall, the proposed program may be useful in improving pain, strength, and mobility in women with knee osteoarthritis. Clinical efficacy needs to be assessed using a randomized controlled trial design. TRIAL REGISTRATION: ClinicalTrials.gov NCT02146105.