Short-Term Effects of Strengthening Exercises of the Lower Limb Rehabilitation Protocol on Pain, Stiffness, Physical Function, and Body Mass Index among Knee Osteoarthritis Participants Who Were Overweight or Obese: A Clinical Trial

Abstract

Background. Osteoarthritis (OA) of the knee is defined as a progressive disease of the synovial joints and is characterized by wear and tear of the cartilage and underlying bone. This study aimed to determine the short-term effects of the lower limb rehabilitation protocol (LLRP) on pain, stiffness, physical function, and body mass index (BMI) among knee OA participants who were overweight or obese. Methodology. A single-blinded randomized controlled trial of one-month duration was conducted at Rehmatul-Lil-Alameen Postgraduate Institute, Lahore, Pakistan. Fifty overweight or obese participants with knee OA were randomly divided into two groups by a computer-generated number. Participants in the rehabilitation protocol group (RPG) were provided with leaflets explaining the strengthening exercises of the LLRP and instruction of daily care (IDC), while the participants in the control group (CG) were provided with leaflets explaining the IDC only for a duration of four weeks. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function. The secondary outcome measures were BMI, exercise adherence, and patients’ satisfaction assessed by using the numeric rating scale ranging from 0 to 10. The paired-sample t-test was used to analyze the differences within groups from baseline to posttest evaluations. The analysis of variance 2 × 2 factor was used to analyze the differences in BMI, knee pain, stiffness, and physical function between the groups. Results. Participants in the RPG and CG reported a statistically significant reduction in knee pain and stiffness ( p ≤ 0.05 ) within the group. The reduction in the scores of knee pain was higher in participants in the RPG than that in participants in the CG ( p = 0.001 ). Additionally, participants in the RPG reported greater satisfaction ( p = 0.001 ) and higher self-reported exercise adherence ( p = 0.010 ) and coordinator-reported exercise adherence ( p = 0.046 ) than the participants in the CG. Conclusion. Short-term effects of the LLRP appear to reduce knee pain and stiffness only, but not physical function and BMI.

Effectiveness of Exercise in Patients with Overweight or Obesity Suffering from Knee Osteoarthritis: A Systematic Review and Meta-Analysis

“…The characteristics of the included studies are provided in Table 1 . Two of the studies were conducted in the United States [ 26 , 27 ]; one in the Netherlands [ 28 ]; one in China [ 29 ]; one in Korea [ 30 ]; and one in Malaysia [ 31 ]. A total of 217 patients (64 ± 5 years old) with overweight or obesity participated in an exercise intervention compared to 193 (63 ± 5 years old) who were recruited to a control group without exercise intervention.…”

“…A total of 217 patients (64 ± 5 years old) with overweight or obesity participated in an exercise intervention compared to 193 (63 ± 5 years old) who were recruited to a control group without exercise intervention. Four studies included only patients with obesity in their sample [ 26 , 27 , 28 , 31 ], while two studies had a sample made up of patients with overweight or obesity [ 29 , 30 ]. The interventions lasted from 1 month [ 31 ] to 18 months [ 26 ], with the mean duration of the interventions being 7.57 ± 6 months.…”

“…Four studies included only patients with obesity in their sample [ 26 , 27 , 28 , 31 ], while two studies had a sample made up of patients with overweight or obesity [ 29 , 30 ]. The interventions lasted from 1 month [ 31 ] to 18 months [ 26 ], with the mean duration of the interventions being 7.57 ± 6 months. Two of the included studies [ 26 , 29 ] incorporated an exercise and diet intervention, in addition to an exercise intervention.…”

“…The six studies included in this meta-analysis included the physical function variable in their results [ 26 , 27 , 28 , 29 , 30 , 31 ], five studies included the pain variable [ 26 , 28 , 29 , 30 , 31 ], and three studies presented the 6MWT variable [ 26 , 27 , 28 ].…”

“…In the studies included in the conducted meta-analysis, Hsu et al, 2021 [ 29 ] conclude that individual diet combined with telemedicine-based resistance exercise intervention significantly improved the body composition, in addition to the blood biochemistry and lower-limb functional performance, of the investigated population with obesity and KO conditions. Nevertheless, Rafiq et al, 2021 [ 31 ] mentioned that short-term effects of the lower-limb rehabilitation protocol appear to reduce knee pain and stiffness only, but not physical function or BMI.…”