Land-based versus water-based walking programs in elderly women with knee osteoarthritis: preliminary results of a randomized clinical trial

Abstract

Introduction: Knee osteoarthritis (kOA) is a chronic degenerativedisorder. Aerobic exercise programs have been effectivetreatments to reduce symptoms in kOA. However, studiescomparing land- and water-based interventions did notcontrol for the intensity of exercise programs. Objectives:Investigate the effects of walking programs with a controlledprogressive workload in water compared to land in terms ofpain, functional and physical performance, and quality oflife in elderly women with kOA. Materials and Methods: Thewalking training programs were divided into two groups:1) land-based aerobic training (LB); and 2) water-based aerobictraining (WB). Each training session was divided intothree phases: 1 – Warm-up (5 minutes): stretching exercises;2 - Training (30 to 55 minutes): walking at target heart rate;3 – Cool-down (5 minutes). Sixteen elderly women with kOAunderwent assessments of functional performance using thesix-minute walk test (6MWT) and the stair test (ST), whilephysical performance, maximum oxygen consumption (VO-2max) and anaerobic threshold (AT) were determined during aprogressive test. kOA was assessed by the Western Ontario andMcMaster Universities Osteoarthritis Index (WOMAC), andquality of life was assessed using the Medical Outcomes Study36-Item Short Form Health Survey (SF-36). All parameters werereevaluated after 12 weeks of aerobic training that consisted ofwalking (duration: 30-55 min.; intensity: 72-82% of maximalheart rate). Results: No significant difference between the LBand WB groups was found. There was a reduction in self-reportedpain (by WOMAC), increased performance in the 6MWTand ST, increased VO2max and VO2max corresponding to ATand improved quality of life (by SF-36) in both groups aftertraining compared with before intervention. Conclusion:Land-based aerobic training was as effective as its water-basedequivalent in clinical, physical and functional parameters inelderly women with knee OA.Keywords: Osteoarthritis of knee; Elderly; Aerobic training.

Efficacy and safety of aquatic exercise in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

“…Nine studies [26][27][28][29]34,[38][39][40]44 compared aquatic exercise with no exercise control; nine studies 30,32,35,[41][42][43][45][46][47] compared aquatic exercise with land-based exercise; and four studies 31,33,36,37 included both no exercise control and land-based exercise comparisons. Seven studies 29,[37][38][39][40]46,47 recorded the follow-up period of outcomes, ranging from 3 to 12 months.…”

“…The initial literature search identified 1095 articles, with 22 studies ( n = 1394) included in this review (Figure 1). 26–47 The mean age of the included participants was 63 years (range 53–71 years). More than 77% of the participants were female ( n = 1077).…”

“…More than 77% of the participants were female ( n = 1077). Seven studies 26,27,32,34,38,42 restricted participants with radiographic assessment of Kellgren and Lawrence Grade III or less, whereas six studies 29,31,35,36,45,47 included participants with radiographic assessment of Kellgren and Lawrence Grade IV.…”

“…Eleven studies (n = 525) [30][31][32][33][35][36][37][41][42][43]47 were included for aquatic exercise compared with landbased exercise, indicating no statistically significant difference in the management of pain between the two groups, with an effect size of −0.12 (95% CI −0.29 to 0.04; Figure 2(b)). For the sensitivity analysis, the meta-analysis was repeated by removing low-quality studies, 30 and there were no appreciable differences, with an effect size of −0.07 (95% CI −0.23 to 0.10).…”

“…Eleven studies (n = 590) 32,33,[35][36][37][41][42][43][45][46][47] were included for aquatic exercise compared with land-based exercise, indicating no statistically significant difference in the management of physical function between the two groups, with an effect size of −0.13 (95% CI −0.28 to 0.02; Figure 4(b)). Sensitivity analysis was not performed because all 11 included studies were rated as high quality.…”