None listed
Conditions
Brief summary
Painful exercise or exercising into pain, is a form of therapeutic exercise that allows temporary aggravation of a person’s pain. In people with chronic pain, painful exercise offers small, short-term benefits in reducing pain compared to non-painful exercise. One potential mechanism for painful exercise is that they typically induce higher loads and dose of exercise and thus likely to evoke a greater analgesic response (reduction of pain following exercise). However, the literature regarding painful versus non-painful exercise is sparse (n=7 trials, n=385 participants) and includes only a small range of chronic pain conditions (e.g. back, shoulder and ankle pain). Moreover, the effect of painful exercise in people with knee osteoarthritis (OA), one of the most prevalent and disabling musculoskeletal conditions in Australia and globally, has not been studied. In addition, there is considerable variability in how painful exercise has been prescribed (e.g. pain allowed versus recommended, measurement of pain during exercise, and the timeframe after exercise for pain to subside), limiting its application in clinical practice. The current project will examine the feasibility of painful exercise compared to non-painful exercise in people with knee OA. This study is significant because, while guidelines recommend different types of exercise (e.g. aerobic and strength exercise for people with knee OA, they do not advise on exercising into pain (or not). Therefore, clinicians must rely on their learnings, prior experiences and patient preferences to prescribe exercise appropriately, but this currently varies considerably in clinical practice with respect to exercising into pain. This may be due to the lack of studies of painful versus non-painful exercise for people with knee OA. This study will provide insight into whether painful exercise under the guidance of AEPs using evidence-based best-practice exercise and education is a feasible intervention for people with knee OA. The outcomes may have implications for how exercise is prescribed in clinical practice in the management of knee OA, including strategies to improve the effectiveness of, and adherence to, exercise in people with knee OA in whom pain and maladaptive beliefs about pain and exercise are often a barrier to treatment engagement.
Interventions
The intervention group will receive the ‘painful’ exercise program, which will be delivered in a one-on one setting by an accredited exercise physiologist. The intervention group will consist of 2x1-hour sessions per week for 6 weeks and include a combination of both aerobic (e.g. stationary cycling/treadmill walking) and upper- and lower-body resistance exercise (e.g. leg press, seated row) as recommended by knee osteoarthritis guidelines. Painful exercise will only be prescribed for the impact
The intervention group will receive the ‘painful’ exercise program, which will be delivered in a one-on one setting by an accredited exercise physiologist. The intervention group will consist of 2x1-hour sessions per week for 6 weeks and include a combination of both aerobic (e.g. stationary cycling/treadmill walking) and upper- and lower-body resistance exercise (e.g. leg press, seated row) as recommended by knee osteoarthritis guidelines. Painful exercise will only be prescribed for the impacted lower extremity muscles (e.g. quadriceps, hamstring, calves and glutes) due to the knee osteoarthritis pain. The painful exercises will be prescribed to evoke a transient increase in knee OA pain at rest, with pain returning to baseline following the exercise session, or within a few hours following exercise (at most 24 hours post-exercise). Participants will be advised to ‘exercise into pain’ which will be monitored through participant self-reports using cues routinely used in clinical practice i.e. exercise whereby pain is ‘manageable/ tolerable’. Pain will also be assessed using a VAS pre and post exercise. Exercise load will be individualised to each participant to ensure the exercise intensity causes the required level of pain. In addition to pain, exercise intensity will also be monitored during each exercise session using the 0-10 rating of perceived exertion scale (RPE). Progression of exercise will entail: Resistance exercises progressed according to the principles of progressive overload (e.g. increase in load when a pre-determined amount of reps have been achieved) and neuromuscular exercises progressed according to principles of graded exercise (e.g. increasing exercise difficulty when a pre-determined number of reps can be completed). Aerobic exercise will be progressed via an increase in volume (e.g. time) and then intensity (e.g. walking speed). Participants will diarise their medication usage during the intervention period. The intervention groups will also receive education designed specifically for this study by the research team, addressing key concepts including benefits of exercise for knee OA and self-management principles (e.g. goal setting, activity pacing, graded activity, medication usage). Education is standardised for both groups and will be delivered throughout the sessions via audio-visual material using oral explanations, summaries, images, metaphors, diagrams and written educational material.
Sponsors
The University of New South Wales
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. aged 18 years or older and are able to speak, read and write English 2. have a diagnosis of symptomatic/painful osteoarthritis in one or both knees and no other leg injuries/disabilities or recent surgeries 3. is medically suitable to perform moderate-intensity exercise
Exclusion criteria
1. the primary cause of pain is something other than knee osteoarthritis 2. have been diagnosed with a serious psychiatric illness (e.g. major depression or severe anxiety) 3. have been diagnosed with a serious cardiovascular, cardiopulmonary or neurological disease that precludes participation in moderate-intensity exercise
Outcome results
None listed