Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]

Carina A Thorstensson, Ewa M Roos, Ingemar F Petersson, Charlotte Ekdahl, Carina A Thorstensson, Ewa M Roos, Ingemar F Petersson, Charlotte Ekdahl

Abstract

Background: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life.

Methods: Patients aged 36-65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at > or = 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months.

Results: Sixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02).

Conclusion: A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group.

Figures

Figure 1
Figure 1
Flowchart of recruitment process and included patients.
Figure 2
Figure 2
Tests of functional performance. A) Åstrand's cycle-ergometer test [24]. B) Rising on one leg from sitting on lowest possible height [25,26]. C) One-leg hop [25], [27]. D) Lateral step-up [28]. E) One-leg semi squatting; maximum number during 30 sec. [26]. F) Heel-rising on one leg; maximum number during 20 sec. [26], [29].
Figure 3
Figure 3
Change in KOOS pain score at six weeks. The individual change in KOOS pain at 6 weeks compared to baseline ranged from improvement to worsening, in both exercise and control group. A change of 10 points or more is considered clinically significant [20]. A similar pattern was seen for all KOOS and SF-36 subscales.

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