Osteoarthritis, Pain
Conditions
Keywords
Osteoarthritis, Pain, Exercise, Function, Cartilage quality
Brief summary
The overall contribution of this study is to increase the knowledge of the efficacy of strength and aerobic exercise on knee related quality of life, knee pain, and physical function in patients with knee osteoarthritis (OA). Knee OA is one of the most important diseases within musculoskeletal conditions affecting a considerable number of people worldwide. This randomized controlled trial will involve one intervention group delivered strength exercises and one group delivered aerobic exercise (ergometer cycling). The two intervention groups will be compared to a control group undergoing usual care. Cost-effectiveness analysis will be performed comparing the three groups. The study is funded from The Research Council of Norway.
Detailed description
The trial aimed to recruit 207 study participants randomly allocated to three arms. The participants had to have symptomatic knee osteoarthritis verified by grade 2-3 using the Kellgren and Lawrence radiographic classification system, and they had to have knee pain most of the days the last month and fulfil 2/3 of the ACR clinical criteria. Participants with other serious comorbidities or self-reported BMI \>35 were included. The interventions consisted of structured strength training program over 12-14 weeks, and a structured stationary cycling program for 12-14 weeks. Primary outcome was the KOOS knee-related quality of life subscale at the 1 year follow-up. Secondary outcomes were other patient reported outcomes, muscle strength, and peak oxygen consumption at the 4-month and 1 year follow-up, and over time (1-year).
Interventions
OTHERStrength training
The strength training will be delivered 2-3 times per week for 12 weeks, 5-8 repetitions maximum in 3 series. The patients must warm up 5 minutes on an ergometer cycle. The following muscle groups will be trained: Quadriceps and hamstrings, hip muscles (abductors and extensors), calf muscles. A home exercise program will be delivered including one leg exercises and balance exercises. Progression will follow a 2+ principle. For instance, when the study participant is able to perform 2 more repetitions, more loads are required.
OTHERAerobic exercise
The aerobic exercise program include ergometer cycling for at least 45 minutes 2-3 times a week on 75-80% of max heart rate will be required.
Sponsors
University Hospital, Akershus
Oslo Metropolitan University
Oslo University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
35 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Women and men aged 35-70 years * Clinical knee OA according to the American College of Rheumatology Clinical Criteria * Kellgren and Lawrence radiographic OA grade 2 and 3 (mild to moderate radiographic OA)
Exclusion criteria
* Severe knee OA according to the Kellgren and Lawrence classification (grade 4) * Other known major musculoskeletal impairments in the lower extremities or the back or prostheses in any joint of the lower extremities * Known coronary heart diseases or cancer * Body mass index \> 35 * Scheduled for surgery in any joint * Known mental or psychologic diseases * Known drug abuse * Persons who already perform sports related moderate physical activity more than two times a week * Contraindications for magnetic resonance imaging (specific point list at Oslo University Hospital, radiographic department) * Not speaking Norwegian language
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Knee-related quality of life | 1 year | Primary outcome for the study will be the quality of life subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) (0-100 scale). 0 is very poor knee-related quality of life, while 100 indicates normal knee-related quality of life. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knee function | 4 months and 1 year | The KOOS is a self-administered knee-specific questionnaire containing 5-item Likert scales on pain, other symptoms, activities of daily living (ADL), function in sports and recreation and knee-related quality of life (QOL). Each scale goes from 0-100, 0 indicating worse function and 100 representing normal function. |
| Health-related quality of life | 4 months and 1 year | Euro Quality of life 5 dimensions 5 level (EQ-5D-5L) will be used to measure health related quality of life. It comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EuroQol (EQ) Visual analogue scale (VAS) records the patient's self-rated health on a vertical visual analogue scale. This can be used as a quantitative measure of health outcome that reflects the patient's own judgement. The scores on these five dimensions can be presented as a health profile or can be converted to a single summary index number (utility) reflecting preferability compared to other health profiles. |
| Radiographic osteoarthritis progression | 2 years | Conventional x-rays will be used to assess radiographic progression of osteoarthritis |
Other
| Measure | Time frame | Description |
|---|---|---|
| Isokinetic muscle strength | 4 months and 1 year | Isokinetic muscle strength will be measured in a Biodex6000 machine. The participants sit in a standardised position and flex/extend their knees at 60 degrees/second. The peak torque value of the five repetitions is recorded. |
| Maximal oxygen consumption (VO2max) | 4 months and 1 year | VO2max is measured using an incremental ramp test procedure on a stationary bike, designed to achieve supramaximal workloads within \ 4-6 min. The workload was increased by 25 watts every 30 second to total exhaustion. |
| Self-efficacy for pain | 4 months and 1 year | Arthritis self-efficacy scale (ASES) was included to measure self-efficacy for pain. A modified version of ASES containing 11 questions regarding the patient's certainty to perform various tasks related to pain and symptoms, where each item is rated from 1 (very uncertain) to 5 (very certain) was used. |
| Total knee replacement | 5 years | We will register continuously numbers of total knee replacements during the follow-up years. |
Countries
Norway
Outcome results
None listed