Educational program promoting regular physical exercise improves functional capacity and daily living physical activity in subjects with knee osteoarthritis

José Messias Rodrigues da Silva, Márcia Uchoa de Rezende, Tânia Carvalho Spada, Lucila da Silva Francisco, Fabiane Elize Sabine de Farias, Cleidnéia Aparecida Clemente da Silva, Claudia Helena de Azevedo Cernigoy, Júlia Maria D'Andréa Greve, Emmanuel Gomes Ciolac, José Messias Rodrigues da Silva, Márcia Uchoa de Rezende, Tânia Carvalho Spada, Lucila da Silva Francisco, Fabiane Elize Sabine de Farias, Cleidnéia Aparecida Clemente da Silva, Claudia Helena de Azevedo Cernigoy, Júlia Maria D'Andréa Greve, Emmanuel Gomes Ciolac

Abstract

Background: Physical exercise and educational programs promote several benefits for patients with knee osteoarthritis (OA). However, little is known about the effects of educational programs promoting the regular practice of physical exercise. The purpose of the present study was to assess the effect of an interdisciplinary educational program, emphasizing the recommendation for regular practice of physical exercise, on functional capacity and daily living physical activity in individuals with knee OA.

Methods: Two hundred and thirty-nine individuals (50 men) with an established diagnosis of knee OA (degree I to IV in the Kelgreen and Lawrence scale) were randomly allocated into a multidisciplinary educational program (EDU; n = 112) or control group (CON; n = 127). Functional capacity (sit and reach, 6-min walking test (6MWT), timed up and down stairs test, timed up and go test (TUGT), and five times sit-to-stand test (FTSST)) and daily living physical activity (IPAQ, short version) were measured before, during (6 months) and after 12 months of follow-up.

Results: Body mass index reduced significantly (P < 0.05) after 6 months, and remained reduced after 12-month of follow-up in EDU, but not in CON. EDU group improved (P < 0.05) timed up and down stairs (19%), TUGT (32.5%) and FTSST (30%) performance after 6 months of follow-up, which remained improved after 12 months of follow-up. Functional capacity did not change in CON, excepted for the timed up and down stairs performance that increased after 6 months (12%, P < 0.05), but returned to levels similar to baseline after 12 months of follow-up. There was also an increase (P < 0.05) in the prevalence of active and very active individuals, as well as a reduction (P < 0.05) in the prevalence of sedentary individuals in EDU group during follow-up. There were no significant changes on sit and reach and 6MWT performance during follow-up in both groups.

Conclusions: The results suggest that an educational program emphasizing the recommendation for regular practice of physical exercise may be an effective tool for improving functional capacity and daily physical activity in individuals with knee OA.

Trial registration: NCT 02335034 , December 22, 2014.

Trial registration: ClinicalTrials.gov NCT02335034.

Keywords: Daily living physical activity; Educational program; Functional capacity; Osteoarthritis; Physical exercise; Physical fitness.

Conflict of interest statement

Ethics approval and consent to participate

The present study was approved by the Ethics Committee for Analysis of Research Projects of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (# CAPPesq 12,671). All volunteers read a detailed description of the protocol and provided their written informed consent.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schematic representation of the study design

References

    1. Brasil . Instituto Brasileiro de Geografia e Estatística. Dados preliminares do Censo 2012 já revelam mudanças na pirâmide etária brasileira. Rio de Janeiro: IBGE; 2012.
    1. Ciolac EG. Exercise training as a preventive tool for age-related disorders: a brief review. Clinics. 2013;68(5):710–717. doi: 10.6061/clinics/2013(05)20.
    1. Ciolac EG, Rodrigues-da-Silva JM. Resistance training as a tool for preventing and treating musculoskeletal disorders. Sports Med. 2016;46(9):1239–1248. doi: 10.1007/s40279-016-0507-z.
    1. Peat G, McCartney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91–97. doi: 10.1136/ard.60.2.91.
    1. Altman RD, Hochberg MC, Moskowitz RW, Schnitzer TJ. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on osteoarthritis guidelines. Arthritis Rheum. 2000;43(9):1905–1915. doi: 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>;2-P.
    1. Vincent KR, Vincent HK. Resistance exercise for knee osteoarthritis. PM R. 2012;4(5 Suppl):S45–S52. doi: 10.1016/j.pmrj.2012.01.019.
    1. Ciolac EG, Silva JM, Greve JM. Effects of resistance training in older women with knee osteoarthritis and total knee arthroplasty. Clinics. 2015;70(1):7–13. doi: 10.6061/clinics/2015(01)02.
    1. Fransen M, McConnell S, Bell M. Exercise of osteoarthritis of the hip or knee. Cochrane Database Syst Rev. 2003;3:CD004286.
    1. de Rezende MU, Campos GC, Pailo AF, Frucchi R, Pasqualin T, Camargo OP. PARQVE-project arthritis recovering quality of life by means of education short-term outcome in a randomized clinical trial. J Arthritis. 2013;2(2):113. doi: 10.4172/2167-7921.1000113.
    1. de Rezende MU, Hissadomi MI, Campos GC, Frucchi R, Pailo AF, Pasqualin T, et al. One-year results of an educational program on osteoarthritis: a prospective randomized controlled trial in Brazil. Geriatr Orthop Surg. 2016;7(2):86–94. doi: 10.1177/2151458516645634.
    1. Ravaud P, Dougados M. Radiographic assessment in osteoarthritis. J Rheumatol. 1997;24(4):786–791.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnositic and therapeutic criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049. doi: 10.1002/art.1780290816.
    1. Hoeger WW, Hopkins DR. A comparison of the sit and reach and the modified sit and reach in the measurement of flexibility in women. Res Q Exerc Sport. 1992;63(2):191–195. doi: 10.1080/02701367.1992.10607580.
    1. Montgomery PS, Gardner AW. The clinical utility of a six-minute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc. 1998;46(6):706–711. doi: 10.1111/j.1532-5415.1998.tb03804.x.
    1. Hinman MR, O'Connell JK, Dorr M, Hardin R, Tumlinson AB, Varner B. Functional predictors of stair-climbing speed in older adults. J Geriatr Phys Ther. 2014;37(1):1–6. doi: 10.1519/JPT.0b013e318298969f.
    1. Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test. Phys Ther. 2005;85(10):1034–1045.
    1. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986;67(6):387–389.
    1. Pardini R, Matsudo S, Araújo T, Matsudo V, Andrade E, Braggion G, et al. Validação do questionário internacional de nível de atividade física (IPAQ - versão 6): estudo piloto em adultos jovens brasileiros. Rev Bras Cien Mov. 2001;9(3):45–51.
    1. Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381. doi: 10.1249/00005768-198205000-00012.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartilage. 2010;18:476–499. doi: 10.1016/j.joca.2010.01.013.
    1. Barlow JH, Turner AP, Wright CC. A randomized controlled study of the arthritis sef-management programme in UK. Health Educ Res. 2000;15(6):665–680. doi: 10.1093/her/15.6.665.
    1. Ravaud P, Filipo RM, Boutron I, Roy C, Mahmoudi A, Giraudeau B, et al. ARTIST (osteoarthritis intervention standardized) study of standardised consultation versus usual care for patients with osteoarthritis of the knee in primary care in France: pragmatic randomised controlled trial. BMJ. 2009;338:b421. doi: 10.1136/bmj.b421.
    1. Ravaud P, Giraudeau B, Logeart I, Larguier JS, Rolland D, Treves R, Euller-Ziegler L, Bannwarth B, Dougados M. Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. Ann Rheum Dis. 2004;63(6):703–708. doi: 10.1136/ard.2003.009803.
    1. de Rezende MU, de Farias FES, da Silva CAC, Cernigoy CHA, de Camargo OP. Objective functional results in patients with knee osteoarthritis submitted to a 2-day educational programme: a prospective randomised clinical trial. BMJ Open Sport Exerc Med. 2016;2(1):e000200. doi: 10.1136/bmjsem-2016-000200.
    1. Rezende MU, Frucchi R, Pailo AF, Campos GC, Pasqualin T, Hissadomi MI. Parqve: project arthritis recovering quality of life through education: two-year results. Acta Ortop Bras. 2017;25(1):18–24. doi: 10.1590/1413-785220172501165604.
    1. Ciolac EG, Greve JM. Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty. Clinics. 2011;66(12):2079–2084. doi: 10.1590/S1807-59322011001200013.
    1. Richardson JLSA, Sinclair S, Harris J, Letts L, MacIntyre NJ, Wilkins S, Burgos-Martinez G, Wishart L, McBay C, Martin Ginis K. Self-management interventions for chronic disease: a systematic scoping review. Clin Rehabil. 2014;28(11):1067–1077. doi: 10.1177/0269215514532478.
    1. Blagojevic MJC, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthr Cartilage. 2010;18(1):24–33. doi: 10.1016/j.joca.2009.08.010.
    1. Rosales AE, Brito NL, Frucchi R, de Campos GC, Pailo AF, de Rezende MU. Obesity, ostearthritis and clinical treatment. Acta Ortop Bras. 2014;22(3):136–139. doi: 10.1590/1413-78522014220300679.
    1. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol. 2006;6(10):772–783. doi: 10.1038/nri1937.
    1. de Oliveira CM, Sakata RK, Issy AM, Gerola LR, Salomão R. Citokines and pain. Rev Bras Anestesiol. 2011;61(2):255–265. doi: 10.1016/S0034-7094(11)70029-0.
    1. Freitas Lima LC, Braga VA, do Socorro de Franca Silva M, Cruz JC, Sousa Santos SH, de Oliveira Monteiro MM, Balarini CM. Adipokines, diabetes and atherosclerosis: an inflammatory association. Front Physiol. 2015;6:304. doi: 10.3389/fphys.2015.00304.
    1. Soares MR, Pereira CAC. Teste de caminhada de seis minutos: valores de referência para adultos saudáveis no Brasil. J Bras Pneumol. 2011;37(5):576–583. doi: 10.1590/S1806-37132011000500003.
    1. Ostir GVMK, Black SA, Goodwin JS. Lower body functioning as a predictor of subsequent disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci. 1998;53(6):M491–M495. doi: 10.1093/gerona/53A.6.M491.
    1. den Ouden MESM, Arts IE, van der Schouw YT. Association between physical performance characteristics and independence in activities of daily living in middle-aged and elderly men. Geriatr Gerontol Int. 2013;13(2):274–280. doi: 10.1111/j.1447-0594.2012.00890.x.

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