Strength Training for Treatment of Osteoarthritis of the Knee a Systematic Review
PM R. Author manuscript; bachelor in PMC 2013 May 1.
Published in final edited form as:
PMCID: PMC3635671
NIHMSID: NIHMS449283
Resistance Exercise for Genu Osteoarthritis
Abstract
The initiation, progression, and severity of knee joint osteoarthritis (OA) has been associated with decreased muscular strength and alterations in articulation biomechanics. Chronic OA pain may lead to anxiety, low, fear of movement, and poor psychological outlook. The fear of motility may foreclose participation in exercise and social events which could lead to farther physical and social isolation. Resistance exercise (RX) has been shown to exist an effective intervention both for decreasing pain and for improving concrete role and self-efficacy. RX may restore muscle strength and joint mechanics while improving physical role. RX may also normalize muscle firing patterns and joint biomechanics leading to reductions in articulation hurting and cartilage deposition. These concrete adaptations could lead to improved cocky-efficacy and decreased feet and low. RX can exist prescribed and performed by patients across the OA severity spectrum. When designing and implementing an RX plan for a patient with knee OA, it is important to consider both the degree of OA severity as well as the level of pain. RX, either in the abode or at a fitness facility, is an important component of a comprehensive regimen designed to offset the physical and psychological limitations associated with knee OA. Unique considerations for this population include: one) monitoring pain during and after exercise, 2) providing days of rest when disease flares occur, and three) infusing diverseness into the practise regimen to encourage adherence.
Keywords: knee, osteoarthritis, resistance do, pain, physical function
Introduction
Knee osteoarthritis (OA) is characterized past hurting, articular cartilage deterioration, joint space narrowing and reduced musculus strength. Approximately 60 million Americans have knee OA and this number will increase by 50% over the next decade.i Knee joint hurting during movement due to OA is a potent predictor of an increased need for functional assistance,2 and is the second leading crusade of disability in the US. iii Approximately x–30% of people diagnosed with OA have pain astringent plenty to limit function and cause disability, and this percentage is increasing.4 Loss of leg muscular force is associated with increased hurting and disability, besides as a more rapid progression of knee OA. Aberrant biomechanics and abnormal joint forces have too been identified as potential culprits underlying OA onset and progression5, 6 Some evidence indicates that aberrant motion at the knee often precedes degenerative changes 7 with decreased tibiofemoral rotation as a mechanism contributing to the development of cartilage degradation. People with medial compartment knee OA demonstrate an internal rotation bias with decreased tibiofemoral rotation compared to their unaffected age matched counterparts 7, 8. Increased ligament stiffness, decreased muscle strength, and alterations in muscle activation patterns are associated with aging and tin can adversely touch on joint kinematics. Suboptimal musculus activation patterns contribute to adverse altercations in joint kinematics during movement. Chronic kinematic alterations can cause degenerative changes in the cartilage, particularly in older adults whose cartilage may no longer take the power to adapt to load bearing. This is a serious issue for the individual with knee OA, as activities such as squatting, stair climbing and kneeling may load the tibial-femoral cartilage surfaces in areas that cannot tolerate the load. Pain, perceived instability, and functional limitations are common downstream effects of this degenerative process. Over time, self-efficacy declines, quality of life deteriorates, and physical dependency and social isolation may ensue. Chronic OA pain may trigger anxiety and depression, which perpetuate the progressive physical and psychological decline associated with the disease.
While options exist to treat hurting due to OA, few treatments can affect the in a higher place mentioned factors underlying OA. Muscle strengthening through resistance exercise (RX) increases physical function, decreases hurting due to OA, and reduces self-reported inability. 5, 9, 10 RX, divers here as the employ of machines (i.east. machines using a weight stack or added weights assuasive selection of a given resistance load) or free weights as the external load, may combat the multi-faceted etiology of OA. This article will synopsize the highest quality bear witness of the effects of RX on OA, and provide clinical guidelines for the prescription and expected adaptations to RX in the knee OA population.
Resistance Practice Programming
Components of a RX programme include resistance load, repetitions, velocity of movement and frequency of sessions per week. A periodic increase in the resistance load for each practice permits continued muscular adaptations over time. Strength is best improved with lifting heavier loads with fewer repetitions, whereas muscle endurance is optimized by lifting lighter weights with more repetitions. RX can exist described in terms of workload (number of repetitions at a given weight). When exercise total workload is kept constant, high-intensity (~6 to viii repetitions at 80% of 1RM) and low-intensity (~12 to 15 repetitions at 60% of 1RM) induce similar strength and wellness adaptations in older men and women.11–13 For knee OA, benefits can be obtained with leg exercises alone, or a combination of lower and upper body exercise for full general strengthening. Bones components of the OA prescription should include seated leg presses (or a variation of a squats), leg extensions and leg curls (with talocrural joint or wrist cuff weights to provide resistance). Inclusion of hip adduction and hip abduction and dogie/toe presses can assist with improving and maintaining appropriate knee joint mechanics.
Initiation of a resistance preparation program requires assessment of force, total knee range of motion, articulatio genus hurting throughout the range of motion, and the patient's access to exercise equipment. Studies unremarkably report practise intensity as the percentage of 1RM at which the exercises are performed. The term "repetition maximum" (RM) refers to the maximal number of times a load tin can be lifted before fatigue using appropriate class and technique (a 1RM = the maximum load that can be lifted once with proper form). Monitoring intensity during an RX program can be achieved by monthly reassessment of the practise 1RM and readjustment of the resistance to provide an appropriate stimulus, or by subjective ratings of muscle endeavour during the exercise (eastward.m., Borg's rating of relative perceived exertion scale).14 The 0–10 or 6–20 points relative perceived exertion (RPE) scales can effectively be used to aid guide the difficulty of exertion during RX for each exercise.15 Hoeger et al15 demonstrated that exercises performed at the same percent of 1RM did not correlate to the same level of perceived difficulty. This may point that using the RPE calibration to monitor effort may allow for each exercise to be performed at a similar level of perceived difficulty.
The severity of knee hurting symptoms at rest and during the 1RM testing will provide important information when developing the initial resistance loads. While the radiographic findings are typically used to phase OA, these data have poor correlation to subjective hurting ratings and functional limitations. Pain and range of motion are therefore more useful indicators of how to initiate and advance a RX program. For example, patients with low to moderate pain (between a i–5 on a10 indicate calibration) may be able to initially tolerate higher loads or repetitions compared with patients who report higher pain levels. A successful program will incorporate exercises to which the patient has access. If admission to RX machines is express or is cost prohibitive, a home based practise program using dumbbells or weight cuffs can be substituted.
Resistance Practice Evidence from Randomized Controlled Trials
Resistance can be applied through diverse methods (i.eastward. torso weight, bands, gratis weights, machines) but for consistency of definition, this review will focus on randomized controlled trials (RCTs) that used weight machines or free weights (please see Table one.).sixteen–21 The most ordinarily utilized regimens involved exercise iii days per week, with 2–iii sets per exercise at viii–xv repetitions per set. Resistance loads varied amidst studies from relatively high resistance (lxxx% 1RM)19 to low resistance (10% 1RM).xx The efficacy of RX on OA symptoms and disability was tested against a variety of other regimens including hydrotherapy (puddle walking),18 aerobic practise (moderate intensity treadmill),16, 22, 23 and range of move exercises (45 minutes of full general multi-joint stretching).21 Other studies compared RX to "sham" RX (minimal leg press and leg extension practise)19, self-management programs, and even health educational control interventions.16, 17 The health education and self management programs provided attention, social interaction, and osteoarthritis educational activity; with exposure to coping skills, promotion of the use adaptive strategies and decreased reliance on avoiding activities or assuasive others to perform the tasks for them. Report samples ranged from 54–365 and were conducted in the United States, Commonwealth of australia and Europe.
Table ane
Randomized controlled trials (RCTs) of resistance exercise for genu OA.
| N | Plan type | Intervention | Follow-up | Pain reduction | Functional Gain | |
|---|---|---|---|---|---|---|
| Ettinger et al.xvi | 365 | Group FAST study | Supervised to abode exercise iii days per week RX: 9 exercises with cuffs and dumbbells, 2 sets of 12 repetitions; one hr AX: walking i hr, 50–75% HRR Wellness education control | 18 months | Likert hurting scale ranging from 0="no pain" to a max of half dozen= "excruciating pain." Pain ↓ to 2.14, 2.21 and 2.41 points in the AX, RX and controls | Self report inability ↓ in both RX and AX groups; 6 minute walk, transfers, lift and carry and motorcar tasks; knee flexion strength ↑; greater benefits occurred with greater compliance. |
| Farr et al.17 | 171 | Group | Supervised 3 days per week RX: leg press, leg curl, hip adduction/abduction, calf raise; progressive ↑ in load upwardly to 60–75% of 3RM Self-management (SM): Educational and behavioral techniques; practice guidelines provided RX + Self management: both | nine months | WOMAC 42% ↓in RX group 31% ↓ in combined group 23% ↓in SM | Boilerplate daily moderate/vigorous physical activity ↑ in RX more than than SM group: RX group had highest strength proceeds in all exercises than other groups. |
| Foley et al.xviii | 105 | Individual | Supervised 3 days per week Hydrotherapy: pool walking and leg strengthening; upward to three sets of 15 reps per exercise RX: bench press, leg press, Hip adduction/abduction; 10RM intensity Control: no do | 6 weeks | WOMAC Pain scores ↓ more in hydrotherapy during the study, but in that location was no difference in scores betwixt exercise groups at calendar week half dozen | Walking speed and isometric quadricep strength ↑ most in RX grouping; walk distance was greater at six weeks in hydrotherapy group. |
| Foroughi et al.45 | 54 | Individual | Supervised 3 days per week RX: leg press, unilateral knee extension, hip abduction, hip adduction, plantar flexion; eighty% 1RM progress 3% if RPE fell beneath range of 15–18 points iii sets of eight repetitions Sham: leg press, leg extension 2 sets of 8 repetitions | 6 months | WOMAC pain scores ↓ in both groups 21–32% (p>0.05) | Greater ↑ in strength occurred in the RX vs Sham group for all exercises; WOMAC part in both groups past 21–31% in both Sham and RX groups, respectively, no difference betwixt groups by month six. |
| Jan et al.20 | 102 | Individual | Supervised three days per week HighR RX: threescore% 1RM, iii sets 8 repetitions per ready LowR RX: 10%1RM, ten sets xv repetitions per set Progression five% ↑ load as Tolerated Control: no do | 2 months | WOMAC 43% ↓in HighR RX 38% ↓ in LowR RX 14% ↓ in command | Walking time on four different terrains (level 60m, figure 8, 13 step stair climb, spongy surface) improved in both RX groups; WOMAC function ↓ 11.3–xi.7% in the LowR and High R RX groups. Isokinetic knee extensor/flexor torque improved most in the HighR RX group. |
| Mikesky et al.21 | 221 | Private | Supervised to dwelling house exercise RX: 3 days per week, transition sessions to abode; Cybex leg press, leg curl, chest press, seated rows; 3 sets of 8–10 repetitions Progression occurred when 12 Repetitions were achieved Range of Motion (ROM) command: Flexibility exercises | thirty months | WOMAC RX did not change pain scores during the study | WOMAC function tended to be better preserved by RX than ROM by month 30; isotonic quadricep and hamstring strength ↑ more in men than women by month xxx. |
| Pennix et al. | 438 | Group FAST report | Supervised to abode practice xviii months 3 month facility and 15 months domicile exercise RX: ix dumbbell exercises AX: walking ane hr at 50–75% HHR Control: monthly pedagogy | Knee pain calibration Pain scores ↓ in both RX and AX groups compared with control | When accounting for knee pain and disability, RX and AX both ↑ walking speed and ↓ pain, with the greater effect from AX by month xviii. | |
| Rejeski et al.23 | 357 | Grouping FAST written report | Supervised to home do 18 months 3 month facility and 15 months home practise RX: ix dumbbell exercises AX: walking one hour at fifty–75% HHR Control: monthly education | Human knee pain scale Hurting scores ↓ in both RX and AX groups compared with control | Stair climb time ↓with RX and efficacy ↑ in both the AX and RX groups. Pain severity and cocky-efficacy mediated the result of exercise on stair climb performance irrespective of exercise type. |
Hurting
Common OA outcomes in these studies were the Western Ontario McMaster Osteoarthritis Index WOMAC pain and part subscores, Likert pain scores, leg force and functional assessments. Some data show that WOMAC pain scores were reduced with 2–9 months of progressive RX by 42–43% compared to 14–23% reported in control type groups.17, xx Compared to the control group (who performed range of motion practise), the RX group demonstrated preserved force and decreased progression of joint space narrowing over a 30 calendar month menstruation. 21 Pain was not different in either group mail-intervention.24 Evidence suggests that pain relief might be dependent in part on exercise intensity; three sets (8 repetitions/prepare) of RX performed at 60% 1RM reduced WOMAC pain scores more than ten sets (xv repetitions/prepare) performed at ten%1RM.25 In one written report past Foley et al.18 70 subjects completed half dozen weeks of hydrotherapy or RX. The WOMAC pain scores did not change with either group. The discrepant findings may be in office due to the severity of OA in the patient grouping recruited,26 or the baseline pain levels of the study groups. For case, 44% of the patients in 1 report were on a joint replacement surgery waiting list.26 Given the prevalence of severe affliction, it is unlikely that meaningful RX-induced changes in knee hurting would be detected among three groups of 35 participants later six weeks of preparation. Mikesky et al. showed that no differences in hurting ratings occurred between RX and control groups after a 12 calendar month plan (supervised to dwelling transition program); half of the participants did not fifty-fifty report pain at the study onset; so information technology is not surprising that a pregnant change in pain was not detected in this study.21
Functional and Strength Improvements
Functional change may be assessed using cocky-report instruments or objective functional tests. Disability questionnaires may inquire objective questions of perceived ability, or have distinct activity subscales relating to airing, stair climbing, transfer activities, upper extremity tasks, bones activities of daily living, and circuitous activities of daily living. Objective functional tests used in these studies include: stair climb and descent times, picking up and carrying a 10 pound weight, and timed job of getting in and out of a simulated car. Longer tasks include the half-dozen minute walk and walking endurance on an aerobic treadmill examination.
Improving walking ability is clinically important every bit it is related to maintenance of functional independence, as well equally a lower risk of mortality and admission to a nursing dwelling house.27 Studies have shown that RX can decrease walking time on level surfaces for 60 meters by eight–10%25 and better half dozen infinitesimal walking distance past an average of 28–45%.28 Other studies have shown increases in median walking speed from 0.97 to approximately 1.12 meters per second (~fifteen% change)26 and 11% increases in habitual gait speed with RX and Sham groups over a six month flow.29 These improvements in gait speed26, 29 are considered clinically relevant.xxx Other tasks such as times to perform climbing a flying of stairs and rise from a chair reverberate the ability of the individual to transfer torso weight. Stair climbing power has been shown to increase by nineteen%28 and self-efficacy of climbing stairs significantly improves later on RX.23 Other data support that chair rise time decreases in similar ranges of 12–28%.25, 28 Hence, in persons with knee OA, these mobility tasks become easier and are performed more than efficaciously after RX training.
Muscle strength of the knee flexors and extensors consistently increases with RX interventions.25, 26, 29 In a study that compared strength comeback with an RX intervention (leg press, leg extension) or a sham intervention (leg press, leg extension) Foroughi et al. found that both groups increased muscle force in the knee joint flexors and extensors likewise equally the hip flexors and abductors with greater changes occurring in the RX group (25–49% force improvement in the RX grouping versus 2–15% increase in the sham group).29 Isokinetic knee torque tin can increment more following college RX intensities (higher resistance loads, fewer repetitions) than low RX intensities (low resistance for high repetition number).20 Dose-dependent improvements in isokinetic force occurred with chair rise fourth dimension, stair climb ability and six minute walking distance post-training, with higher intensity exercise inducing the greatest change with no agin safety problems. Specifically, walking time to complete a 12 meter walk on a spongy surface decreases by 42%–l% following low and high intensity RX and the time to complete a figure eight pattern with two 50 meter circles decreases by 38% to 45%.25 An reward of a loftier intensity program is decreased total work-out time which may improve adherence. Long term studies that are initially supervised and transition to home based programs show that genu extensor and flexor torque increased most during the initial iii–half dozen month phase then muscle force slowly declines over the following years afterward the transition occurred.31 These data back up the concept that improvements in symptoms and office are direct related to do intensity and that college intensity RX (if maintained over time) would sustain musculus strength and preserve functional abilities. Figure 1 summarizes a potential pathway past which RX improves OA symptoms and disability.
Summary of principal effects of resistance exercise (RX) on key musculoskeletal mechanisms underlying knee OA.
Can Leg Exercise Lone Meliorate Strength or OA Symptoms?
The question of whether focused knee extension and flexion RX can arm-twist a similar magnitude of OA symptom relief as a comprehensive RX program remains unclear due to limited show. However, a small study used isolated RX of the articulatio genus extensors and flexors to treat patients with knee joint OA.32 Supervised RX was performed once a week using machines, at the intensity of 50% of the maximum peak torque for iii sets at twenty repetitions. This was supplemented with thirty daily isometric strengthening exercises of the quadricep and hamstring muscles. The symptomatic leg produced less maximal articulatio genus extensor and flexor torques compared with the asymptomatic leg at baseline. However, later on three to six months of preparation, the improvements in torque values were significantly greater in the symptomatic leg (72.5% vs 46.9% extension, 63.6% vs. 31.0% flexion). While adherence was not reported for exercise subsequently month half-dozen, the strength improvements were maintained for three years. Hence, even isolated knee extension and flexion practice can induce large improvements in forcefulness, particularly in the more painful knee joint. Unfortunately this study did not document changes in pain or functional ability.
Severe OA: A Role for Resistance Practise?
Importantly, even persons with severe OA who are awaiting a joint replacement tin can participate in high intensity RX and experience satisfaction with handling, without worsening knee pain or inducing adverse events.18 Exploratory studies also prove that RX can positively increase the Genu Injury and Osteoarthritis Event Score (KOOS) in the domains of hurting, symptoms, activities of daily living, and quality of life.33 While RX may not induce the aforementioned magnitude of symptom reduction and functional comeback in severe knee joint OA compared with less severe disease, performing strengthening practise nonetheless confers positive benefits. For case, prehabilitation with RX prior to genu replacement may raise postoperative recovery and functional gains after the procedure and reduce muscle strength asymmetries between the surgical and not-surgical leg.34 This is clinically relevant because preoperative functional status is predictive of postoperative functioning on a variety of functional tasks, and preoperative quadriceps force is a predictor of physical part (e.g., stair climb, chair rise) at one year later knee replacement.35 These information provide compelling evidence that RX tin be helpful even in end stage knee OA.
Psychological Importance of Resistance Do in Knee OA
Maintenance of positive psychological well being is critical in the prevention of worsening disability in the OA population. Benefits of RX extend across pain relief and functional improvement, and tin include psychosocial well being. Psychological well-being typically encompasses positive components such as cerebral function, positive affect, enhanced cocky-efficacy and cocky-esteem with the absence of feet, depression, and negative stress-related emotions.36
Self efficacy, Anxiety and Depression
Chronic OA hurting may atomic number 82 to feet, depressive symptoms and poor psychological outlook.37, 38 Self-efficacy beliefs are clinically important because the confidence that 1 can exercise, despite individual constraints and impediments such as lack of time and fatigue are associated with a greater likelihood of success with healthy behaviors. Patients with low self-efficacy are more probable to avoid physical activity in their daily routine.23 Older adults who participate in whole torso RX experience a sense of accomplishment and control over their wellness with the achievement of a new concrete competency. Participants may accept responsibility for their wellness with the intent of preventing health problems afterward.39 A sub-analysis from an exercise intervention RCT in knee OA revealed that RX tin can increment self-efficacy for stair climbing every bit much as aerobic exercise, and this is in function mediated by pain reduction.23 As self-efficacy decreases, trust in cocky to perform physical function declines. Co-ordinate to Maly, people with knee OA demonstrate a concept termed "careful mobility,"forty represented by cautious behaviors such equally slow walking velocity, increased stance time, reduced joint angles, and decreased range of move.
Concurrent with forcefulness gains, RX can reduce anxiety, meliorate mood and reduce the risk of low in older adults when regimens involve resistance loads of 80% 1RM for ii sets of eight repetitions of six exercises.37 Even among depressed elders, RX confers a 46% reduction in Beck Depression Inventory scores compared to a 20% reduction in controls.38 Quality of life subscores of role emotional, social functioning and bodily pain are all improved with RX.
Resistance Exercise Prescription for Knee OA
The prescription of RX for knee OA is provided in Table 2. Notation that as the severity of the OA hurting increases, modifications to the initial program and progression should be made for patient comfort and adherence. In full general, the initiation phase of RX programs can involve strengthening practise twice a week and work up to three times a week. The initial resistance loads and the range of movement of the exercises tin be tailored to the patient tolerance. The goal should be to encourage training at an intensity to induce an RPE of thirteen–15 ("somewhat hard" to "hard"). The joint range of movement for the different leg exercises should be fix as the maximum range that tin be tolerated by the patient. During the progression stage the resistance loads or number of weekly sessions can be increased every bit the patient gains forcefulness, confidence, and becomes skilled at rating muscle endeavor and interpreting knee pain during the practise. A minimum of 24 hours residuum between sessions should be implemented. Maintenance of strength gains and function over time tin can be achieved by performing leg exercises at an intensity that induces an RPE of xv–xvi. Diverseness in the exercise plan can be infused with unlike leg exercises, performing unilateral versus bilateral exercise, or substituting gratuitous weight practice such equally squats with dumbbells, lunges, or stride ups on to a stair or platform while holding light weights. Variety within the RX program fosters adherence and reduces stagnation. Past post-obit some guidelines for the relative RX activity (Table 3), injury adventure is minimized in persons with articulatio genus OA.
Tabular array 2
Resistance exercise (RX) guidelines and prescription for individuals with human knee OA.
| Severity of Articulatio genus Hurting | Mild (ane–four points out of ten) | Moderate (5–7 points out of ten) | Astringent (>7 points out of 10) |
|---|---|---|---|
| INTIATION | 2 days a week | 2 days a calendar week | 2 days a week |
| 40% 1RM | 40% 1RM | 30% 1RM | |
| RPE 13–15 | RPE 13–15 | RPE thirteen | |
| Encourage total knee ROM | Encourage full knee ROM or ROM as tolerated | ROM every bit tolerated | |
| Notes: | Water ice and manage pain as needed | Accept day off if flare is bad | Take day off if flare is bad |
| Manage pain as needed | Ice and manage pain as needed | ||
| PROGRESSION | Increase RPE upwardly to 15–xvi over 8 weeks | Increment RPE upwards to 15–16 over 8 weeks | Increase RPE as tolerated or up to 15 |
| Increase frequency upwardly to 3 days a week, at least 24 hrs betwixt sessions | Increase frequency upwards to three days a week, at to the lowest degree 24 hrs betwixt sessions | 2 days per week, if tolerated, potentially up to 3 sessions per week; at to the lowest degree 24 hrs between sessions | |
| MAINTENANCE | Maintain ii–3 days per week | Maintain 2–three days per week | Maintain two–3 days per week |
| Arrange resistance load to keep RPE at 15–16 | Accommodate resistance load to keep RPE at 15–16 | Arrange resistance load to keep RPE ≤fifteen |
Table 3
Relative RX activity guidelines for knee OA
RX Progression:
|
Pain and Exercise:
|
In patients with severe pain (exceeding 7 out of ten), physicians should consider commencement with physical therapy and pharmaceutically controlling pain prior to adding greater resistance loads. An of import signal is that RX programs for OA need to be flexible to accommodate the illness flares and episodic pain bouts. Our experience revealed that small-scale modifications to the prescription (particularly to reducing resistance load and/or range of move) on "bad days" permits the patient to continue exercising, improves adherence, and bolsters cocky-confidence that they can still accomplish an practice session. Within a few days, the patient may exist back at the designated grooming load and articulation move.
Translation of Principles into Medical Practice
Prescription of RX for the treatment of mild to moderate knee OA volition provide multiple benefits including symptom relief, less inability, improved functional chapters and overall health. It is of import to notation that admission to facilities that firm resistance exercise equipment, or formal RX programs may be cost prohibitive. In such cases, home-based RX programs that use body weight, therabands, dumbbells and gage weight may confer substantial benefit against adverse OA sequelae. For example, functional activities combined with strengthening exercise with weight cuffs (squats and footstep-ups, knee extension/flexion, hip abduction/adduction) performed three times a week can elicit 43% reductions in pain with concurrent improvements in leg strength, stair climb time and repeated chair stand up fourth dimension.41 Other home-based programs and telephone prompted programs that use graded elastic bands for leg exercise can besides significantly reduce OA pain symptoms compared to no do,42–44 and improve the power perform trunk transfers with less pain.43 Thus, an initial purchase of select inexpensive resistance exercise items, coupled with a booklet with 5–viii exercises or dynamic activities describing the technique, load and repetition structure with guidance of progression, is a suitable alternative for patients with knee joint OA.
Decision
RX exercise is a vital component of the treatment for some of the underlying mechanisms of knee OA, including muscle forcefulness insufficiency, muscle activation imbalance and aberrant biomechanics and cartilage loading. RX can exist modified based on the patient symptoms and access to equipment. Progression and maintenance of benefits can be safely achieved past post-obit the guidelines presented here.
Acknowledgments
The authors are U.s.a. Bone and Joint Decade Scholars. This work was partly supported by NIH NIAMS grants AR059786 and AR057552-01A1.
Footnotes
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635671/