The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee

doi:10.1053/apmr.2002.33988

Archives of Physical Medicine and Rehabilitation

Volume 83, Issue 9, September 2002, Pages 1187-1195

https://doi.org/10.1053/apmr.2002.33988 Get rights and content

Abstract

Topp R, Woolley S, Hornyak J III, Khuder S, Kahaleh B. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Arch Phys Med Rehabil 2002;83:1187-95. Objective: To compare 16 weeks of isometric versus dynamic resistance training versus a control on knee pain and functioning among patients with knee osteoarthritis (OA). Design: Randomized clinical trial. Setting: Outpatient setting. Participants: A total of 102 volunteer subjects with OA of the knee randomized to isometric (n=32) and dynamic (n=35) resistance training groups or a control (n=35). Interventions: Strength exercises for the legs, 3 times weekly for 16 weeks. Dynamic group: exercises across a functional range of motion; isometric: exercises at discrete joint angles. Main Outcome Measures: The time to descend and ascend a flight of 27 stairs and to get down and up off of the floor. Knee pain was assessed immediately after each functional task. The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess perceived pain, stiffness, and functional ability. Results: In the isometric group, time to perform all 4 functional tasks decreased (P<.05) by 16% to 23%. In the dynamic group, time to descend and ascend stairs decreased by 13% to 17%. Both groups decreased knee pain while performing the functional tasks by 28% to 58%. Other measures of pain and functioning were significantly and favorably affected in the training groups. The improvements in the 2 training groups as a result of their respective therapies were not significantly different. The control group did not change over the duration of the study. Conclusion: Dynamic or isometric resistance training improves functional ability and reduces knee joint pain of patients with knee OA. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Sample

One hundred two community-dwelling women (n=74, 72.5%) and men (n=28, 27.5%) previously diagnosed with knee OA volunteered and participated in the present study. Subjects were recruited from physician offices, local senior centers, and local arthritis support groups. Subjects were included if, during an initial telephone interview, they reported a moderate degree of knee pain because of OA as evidenced by a score of 5 or greater on the Western Ontario and McMaster Universities Osteoarthritis

Results

Analyses of the data were conducted in 2 steps. The first step was to examine the sample at baseline for group differences in potentially confounding demographic or background variables. In this first step we also determined differences within or between the treatment groups in medication dose effect over the duration of the study. Table 1 presents comparisons between the continuous and discrete demographic variables collected from the sample at baseline.

. Demographic characteristics of the sample

Discussion

These findings answered the study's 2 research questions. Both dynamic and isometric resistance training reduced perceived knee joint pain and had no effect on perceived joint stiffness. Only the dynamic training reduced perceived functional limitations, and the control group did not change their measures on any of the outcome variables over the duration of the study.

The findings are consistent with previous investigators who have reported that exercise can reduce pain and increase the

Conclusion

The results of the present study support the efficacy of prescribing various resistance-training programs with Thera-Band elastic bands to patients with OA of the knee as a method to enhance their functional ability and to reduce their knee joint pain.

References (64)

CS. Burckhardt
Chronic pain
Nurs Clin North Am
(1990)
W Ettinger et al.
Long-term physical functioning in persons with knee osteoarthritis from NHANES I: effects of comorbid medical conditions
J Clin Epidemiol
(1994)
MV. Hurley
The role of muscle weakness in the pathogenesis of osteoarthritis
Rheum Dis Clin North Am
(1999)
NM Fisher et al.
Effects of a muscle exercise program on exercise capacity in subjects with osteoarthritis
Arch Phys Med Rehabil
(1994)
NM Fisher et al.
Effects of a quantitative progressive rehabilitation program applied unilaterally to the osteoarthritic knee
Arch Phys Med Rehabil
(1993)
NM Fisher et al.
Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees
Arch Phys Med Rehabil
(1993)
JR Meuleman et al.
Exercise training in the debilitated aged: strength and functional outcomes
Arch Phys Med Rehabil
(2000)
DE Krebs et al.
Moderate exercise improves gait stability in disabled elders
Arch Phys Med Rehabil
(1998)
H Rogind et al.
The effect of a physical training program on patients with osteoarthritis of the knees
Arch Phys Med Rehabil
(1998)
WJ Phipps et al.
Medical-surgical nursing: concepts and clinical practice
(1994)

JS Lawrence et al.

Osteo-arthrosis: prevalence in the population and relationship between symptoms and x-ray changes

Ann Rheum Dis

(1966)

WO Spitzer et al.

The arthritis complaint in primary care: prevalence, related disability and cost

J Rheum

(1976)

JA. Barondess

The future of generalism

Ann Intern Med

(1993)

A Praemer et al.

Costs of musculoskeletal conditions

EH. Yelin

The impact of osteoarthritis

WJ Rejeski et al.

Self-efficacy and pain in disability with osteoarthritis of the knee

Gerontol B Psychol Sci Soc Sci

(1996)

NM Fisher et al.

Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis

Arch Phys Med Rehabil

(1991)

TE McAlindon et al.

Determinants of disability in osteoarthritis of the knee

Ann Rheum Dis

(1993)

S Messier et al.

Osteoarthritis of the knee: effects on gait, strength, and flexibility

Arch Phys Med Rehabil

(1992)

LO Nordesjo et al.

Isometric strength and endurance in patients with severe rheumatoid arthritis or osteoarthrosis in the knee joints

Scand J Rheum

(1983)

L Sharma et al.

Does laxity alter the relationship between strength and physical function in knee osteoarthritis

Arthritis Rheum

(1999)

LM Koralewicz et al.

Comparison of proprioception in arthritic and age-matched normal knees

J Bone Joint Surg Am

(2000)

R Topp et al.

Predictors of four functional tasks in patients with osteoarthritis of the knee

Orthop Nurs

(2000)

DM Buchner et al.

The Seattle FICSIT/MoveIt study: the effect of exercise on gait and balance in older adults

J Am Geriatr Soc

(1993)

MA Fiatarone et al.

Exercise in the oldest old

Top Geriatr Rehabil

(1990)

WR Frontera et al.

Strength conditioning in older men: skeletal muscle hypertrophy and improved function

J Appl Physiol

(1988)

R Topp et al.

The effect of a 12-week dynamic resistance training program on gait velocity and balance of older adults

Gerontologist

(1993)

AL Morgan et al.

The supplemental benefits of resistance training for aerobically active postmenopausal women

J Aging Phys Act

(1995)

MA Fiatarone et al.

Exercise training and nutritional supplementation for physical frailty in very elderly people

N Engl J Med

(1994)

SP Messier et al.

Effects of long term aerobic or weight training regimens on gait in an older osteoarthritic population

J Appl Biomech

(1997)

SP Messier et al.

Long-term exercise and its effect on balance in older osteoarthritic adults: results from the fitness, arthritis, and seniors trial

Am Geriatr Soc

(2000)

WH Ettinger et al.

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)

JAMA

(1997)

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What are the unsupervised exercise adherence rates in clinical trials for knee osteoarthritis? A systematic review
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Exercise is an effective intervention for knee osteoarthritis (OA), and unsupervised exercise programs should be a common adjunct to most treatments. However, it is unknown if current clinical trials are capturing information regarding adherence.
To summarize the extent and quality of reporting of unsupervised exercise adherence in clinical trials for knee OA.
Reviewers searched five databases (PubMed, CINAHL, Medline (OVID), EMBASE and Cochrane). Randomized controlled trials where participants with knee OA engaged in an unsupervised exercise program were included. The extent to which exercise adherence was monitored and reported was assessed and findings were subgrouped according to method for tracking adherence. The types of adherence measurement categories were synthesized. A quality assessment was completed using the Physiotherapy Evidence Database (PEDro) scores.
Of 3622 abstracts screened, 176 studies met criteria for inclusion. PEDro scores for study quality ranged from two to ten (mean=6.3). Exercise adherence data was reported in 72 (40.9%) studies. Twenty-six (14.8%) studies only mentioned collection of adherence. Adherence rates ranged from 3.7 to 100% in trials that reported adherence. For 18 studies (10.2%) that tracked acceptable adherence, there was no clear superiority in treatment effect based on adherence rates.
Clinical trials for knee OA do not consistently collect or report adherence with unsupervised exercise programs. Slightly more than half of the studies reported collecting adherence data while only 40.9% reported findings with substantial heterogeneity in tracking methodology. The clinical relevance of these programs cannot be properly contextualized without this information.
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2023, Annals of Physical and Rehabilitation Medicine
Systematic reviews of exercise therapy for knee osteoarthritis (OA) have largely ignored the variability in comparator interventions.
To assess how effect estimates of exercise therapy for knee OA as reported in randomized controlled trials vary depending on the comparator interventions.
We followed the Cochrane Handbook and PRISMA guidance to conduct and report this meta-epidemiological study. Randomised controlled trials (RCTs) were identified from systematic reviews published in 2015 or later and reference lists of included studies. Exercise therapy RCTs testing interventions that adhered to the American College of Sports Medicine (ACSM) guidelines compared to any comparator intervention in people with knee OA and reporting outcomes of knee pain, physical function and/or quadriceps strength at the end of intervention were included.
Thirty-five RCTs with 2412 participants were included. Comparator interventions included no intervention, non-ACSM compliant exercise therapy, education/self-management, and passive modalities. For pain, standardized mean difference (SMD) for ACSM compliant exercise therapy compared to passive modalities was 1.76 (95% CI 0.49, 3.04), no intervention 0.93 (95% CI 0.50; 1.36), education/self-management 0.27 (95% CI 0.07, 0.47), and non-ACSM compliant exercise therapy 0.09 (95% CI -0.06, 0.23). For physical function, SMD for ACSM compliant exercise therapy compared to passive modalities was 1.29 (95% CI 0.41, 2.17), no intervention 0.76 (95% CI 0.15, 1.36), non-ACSM compliant exercise therapy 0.25 (95% CI -0.00, 0.51) and education/self-management 0.21 (95% CI -0.14, 0.55). For quadriceps strength, SMD for ACSM compliant exercise therapy compared to no intervention was 0.69 (95% CI 0.42, 0.96), non-ACSM compliant exercise therapy 0.23 (95% CI -0.01, 0.46), education/self-management -0.02 (95% CI -0.45, 0.42) and passive modalities 0.80 (95% CI -0.10, 1.71).
The effect of exercise therapy for knee OA varies significantly depending on the comparator intervention. This variability should be assessed routinely in systematic reviews.
Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading
2020, Journal of Orthopaedic Translation
Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients’ quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA.
Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.
Effects of blood flow restriction therapy in patients with knee osteoarthritis: protocol for an overview of systematic reviews
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The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis
2023, PM and R
Exercise Therapy for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis
2023, Orthopaedic Journal of Sports Medicine

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^☆: Supported by the National Institute for Nursing Research (grant no. R01 NR04515) and the Hygenic Corporation.

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

^★: Reprint requests to Robert Topp, RN, PhD, Schl of Nursing, Medical College of Georgia, 997 St Sebastian Way, Augusta, GA 30912, e-mail: [email protected].

^★★: Supplier

^♢: a. The Hygenic Corp, 1245 Home Ave, Akron, OH 44310.

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ArticlesThe effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee☆,☆☆,★,★★,♢

Abstract

Section snippets

Sample

Results

Discussion

Conclusion

Nurs Clin North Am

J Clin Epidemiol

Rheum Dis Clin North Am

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Medical-surgical nursing: concepts and clinical practice

Osteo-arthrosis: prevalence in the population and relationship between symptoms and x-ray changes

Ann Rheum Dis

The arthritis complaint in primary care: prevalence, related disability and cost

J Rheum

The future of generalism

Ann Intern Med

Costs of musculoskeletal conditions

The impact of osteoarthritis

Self-efficacy and pain in disability with osteoarthritis of the knee

Gerontol B Psychol Sci Soc Sci

Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis

Arch Phys Med Rehabil

Determinants of disability in osteoarthritis of the knee

Ann Rheum Dis

Osteoarthritis of the knee: effects on gait, strength, and flexibility

Arch Phys Med Rehabil

Isometric strength and endurance in patients with severe rheumatoid arthritis or osteoarthrosis in the knee joints

Scand J Rheum

Does laxity alter the relationship between strength and physical function in knee osteoarthritis

Arthritis Rheum

Comparison of proprioception in arthritic and age-matched normal knees

J Bone Joint Surg Am

Predictors of four functional tasks in patients with osteoarthritis of the knee

Orthop Nurs

The Seattle FICSIT/MoveIt study: the effect of exercise on gait and balance in older adults

J Am Geriatr Soc

Exercise in the oldest old

Top Geriatr Rehabil

Strength conditioning in older men: skeletal muscle hypertrophy and improved function

J Appl Physiol

The effect of a 12-week dynamic resistance training program on gait velocity and balance of older adults

Gerontologist

The supplemental benefits of resistance training for aerobically active postmenopausal women

J Aging Phys Act

Exercise training and nutritional supplementation for physical frailty in very elderly people

N Engl J Med

Effects of long term aerobic or weight training regimens on gait in an older osteoarthritic population

J Appl Biomech

Long-term exercise and its effect on balance in older osteoarthritic adults: results from the fitness, arthritis, and seniors trial

Am Geriatr Soc

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)

JAMA

Articles
The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee☆,☆☆,★,★★,♢