Effects of computer-aided rowing exercise systems on improving muscle strength and function in older adults with mild knee osteoarthritis: a randomized controlled clinical trial

Pei-Ling Lin, Lee-Fen Yu, Shu-Fen Kuo, Xin-Miao Wang, Liang-Hsuan Lu, Chueh-Ho Lin, Pei-Ling Lin, Lee-Fen Yu, Shu-Fen Kuo, Xin-Miao Wang, Liang-Hsuan Lu, Chueh-Ho Lin

Abstract

Background: Osteoarthritis (OA) is common in aged adults and can result in muscle weakness and function limitations in lower limbs. Knee OA affects the quality of life in the elderly. Technology-supported feedback to achieve lower impact on knee joints and individualized exercise could benefit elderly patients with knee OA. Herein, a computer-aided feedback rowing exercise system is proposed, and its effects on improving muscle strength, health conditions, and knee functions of older adults with mild knee OA were investigated.

Methods: Thirty-eight older adults with mild knee OA and satisfying the American College of Rheumatology (ACR) clinical criteria participated in this randomized controlled clinical trial. Each subject was randomly assigned to a computer-aided rowing exercise (CRE) group (n = 20) or a control group (CON) (n = 18) that received regular resistance exercise programs two times per week for 12 weeks. Outcome measurements, including the Western Ontario and MacMaster Universities (WOMAC), muscle strength and functional fitness of the lower limbs, were evaluated before and after the intervention.

Results: Participants' functional fitness in the CRE group exhibited significantly higher adjusted mean post-tests scores, including the WOMAC (p = 0.006), hip abductors strength (kg) (MD = 2.36 [1.28, 3.44], p = 5.67 × 10-5), hip adductors strength (MD = 3.04 [1.38, 4.69], p = 0.001), hip flexors strength (MD = 4.01 [2.24, 5.78], p = 6.46 × 10-5), hip extensors strength (MD = 2.88 [1.64, 4.12], p = 4.43 × 10-5), knee flexors strength (MD = 2.03 [0.66, 3.41], p = 0.005), knee extensors strength (MD = 1.80 [0.65, 2.94], p = 0.003), and functional-reach (cm) (MD = 3.74 [0.68, 6.80], p = 0.018), with large effect sizes (η2 = 0.17-0.42), than those in the CON group after the intervention.

Conclusions: Older adults with knee OA in the CRE group exhibited superior muscle strength, health conditions, and functional fitness improvements after the 12-week computer-aided rowing exercise program than those receiving the conventional exercise approach.

Trial registration: The Institutional Review Board of the Taipei Medical University approved the study protocol (no. N201908020, 27/05/2020) and retrospectively registered at ClinicalTrials.gov (trial registry no. NCT04919486, 09/06/2021).

Keywords: Computer-aided system; Lower joint impact; Older adults; Osteoarthritis; Rowing exercise; WOMAC.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of the randomization procedure and outcome measurements of the study
Fig. 2
Fig. 2
Participant performing the computer-aided rowing exercise in front of the liquid crystal display (LCD) monitor

References

    1. Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis Cartilage. 2011;19(11):1270–1285.
    1. Lo J, Chan L, Flynn S. A Systematic Review of the Incidence, Prevalence, Costs, and Activity and Work Limitations of Amputation, Osteoarthritis, Rheumatoid Arthritis, Back Pain, Multiple Sclerosis, Spinal Cord Injury, Stroke, and Traumatic Brain Injury in the United States: A 2019 Update. Arch Phys Med Rehabil. 2021;102(1):115–131.
    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2163–2196.
    1. Lethbridge-Cejku M, Helmick CG, Popovic JR. Hospitalizations for arthritis and other rheumatic conditions: data from the 1997 National Hospital Discharge Survey. Med Care. 2003;41(12):1367–1373.
    1. Brandt KD, Doherty M, Lohmander LS. Osteoarthritis: Oxford University Press; 1998:23–30.
    1. Mesa-Castrillon CI, Simic M, Ferreira ML, Hatswell K, Luscombe G, de Gregorio AM, Davis PR, Bauman A, Bunker S, Clavisi O, et al. EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol. BMC Musculoskelet Disord. 2021;22(1):11.
    1. Primorac D, Molnar V, Matisic V, Hudetz D, Jelec Z, Rod E, Cukelj F, Vidovic D, Vrdoljak T, Dobricic B, et al. Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies' Guidelines. Pharmaceuticals (Basel) 2021;14(3):205.
    1. Cole BJ, Harner CD. Degenerative arthritis of the knee in active patients: evaluation and management. J Am Acad Orthop Surg. 1999;7(6):389–402.
    1. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum. 2014;43(6):701–712.
    1. Roddy E, Zhang W, Doherty M, Arden N, Barlow J, Birrell F, Carr A, Chakravarty K, Dickson J, Hay E. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus. Rheumatology. 2004;44(1):67–73.
    1. Lee AC, Harvey WF, Han X, Price LL, Driban JB, Bannuru RR, Wang C. Pain and functional trajectories in symptomatic knee osteoarthritis over up to 12 weeks of exercise exposure. Osteoarthritis Cartilage. 2018;26(4):501–512.
    1. Arden NK, Perry TA, Bannuru RR, Bruyère O, Cooper C, Haugen IK, et al. Non-surgical management of knee osteoarthritis: comparison of ESCEO and OARSI 2019 guidelines. Nat Rev Rheumatol. 2021;17(1):59–66.
    1. Peeler J, Ripat J. The effect of low-load exercise on joint pain, function, and activities of daily living in patients with knee osteoarthritis. Knee. 2018;25(1):135–145.
    1. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589.
    1. van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care. 2020;18(4):575–595.
    1. Zeng CY, Zhang ZR, Tang ZM, Hua FZ. Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis. Front Physiol. 2021;12:794062.
    1. Varady NH, Grodzinsky AJ. Osteoarthritis year in review 2015: mechanics. Osteoarthritis Cartilage. 2016;24(1):27–35.
    1. Chen PY, Song CY, Yen HY, Lin PC, Chen SR, Lu LH, Tien CL, Wang XM, Lin CH. Impacts of tai chi exercise on functional fitness in community-dwelling older adults with mild degenerative knee osteoarthritis: a randomized controlled clinical trial. BMC Geriatr. 2021;21(1):449.
    1. Cui H, Wang Q, Pedersen M, Wang Q, Lv S, James D, Larkey L. The safety of tai chi: A meta-analysis of adverse events in randomized controlled trials. Contemp Clin Trials. 2019;82:85–92.
    1. Lan C, Chen SY, Lai JS, Wong AM. Tai chi chuan in medicine and health promotion. Evid Based Complement Alternat Med. 2013;2013:502131.
    1. Chan AW, Yu DS, Choi K. Effects of tai chi qigong on psychosocial well-being among hidden elderly, using elderly neighborhood volunteer approach: a pilot randomized controlled trial. Clin Interv Aging. 2017;12:85.
    1. Zhu Q, Huang L, Wu X, Wang L, Zhang Y, Fang M, Liu Y, Li JX. Effects of Tai Ji Quan training on gait kinematics in older Chinese women with knee osteoarthritis: A randomized controlled trial. J Sport Health Sci. 2016;5(3):297–303.
    1. Chen YW, Hunt MA, Campbell KL, Peill K, Reid WD. The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses. Br J Sports Med. 2016;50(7):397–407.
    1. Day L, Hill KD, Jolley D, Cicuttini F, Flicker L, Segal L. Impact of tai chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(8):1400–1407.
    1. Oh H, Lee S, Lee K, Choi J. The effects of visual feedback balance training on the pain and physical function of patients with chronic degenerative knee arthritis. J Phys Ther Sci. 2020;32(9):563–565.
    1. Richards R, van den Noort JC, van der Esch M, Booij MJ, Harlaar J. Gait retraining using real-time feedback in patients with medial knee osteoarthritis: Feasibility and effects of a six-week gait training program. Knee. 2018;25(5):814–824.
    1. Oh HT, Hwangbo G. The effects of proprioception exercise with and without visual feedback on the pain and balance in patients after total knee arthroplasty. J Phys Ther Sci. 2018;30(1):124–126.
    1. Byra J, Czernicki K. The Effectiveness of Virtual Reality Rehabilitation in Patients with Knee and Hip Osteoarthritis. J Clin Med. 2020;9(8):2639.
    1. Christiansen CL, Bade MJ, Davidson BS, Dayton MR, Stevens-Lapsley JE. Effects of Weight-Bearing Biofeedback Training on Functional Movement Patterns Following Total Knee Arthroplasty: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2015;45(9):647–655.
    1. Ettinger WH, Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis The Fitness Arthritis and Seniors Trial (FAST) Jama. 1997;277(1):25–31.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke T, Greenwald R, Hochberg M. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1986;29(8):1039–1049.
    1. Trivedi D. Cochrane Review Summary: Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Prim Health Care Res Dev. 2017;18(6):527–528.
    1. Turner MN, Hernandez DO, Cade W, Emerson CP, Reynolds JM, Best TM. The Role of Resistance Training Dosing on Pain and Physical Function in Individuals With Knee Osteoarthritis: A Systematic Review. Sports Health. 2020;12(2):200–206.
    1. Lin DH, Lin CH, Lin YF, Jan MH. Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(6):450–457.
    1. Yang H-H, Wang T-J, Chen W-Y. Clinical Measures as Predictors of Disability in Patients with Knee Osteoarthritis. Formosan Journal of Physical Therapy. 2004;29(4):233–241.
    1. Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, Imoto AM, Toupin-April K, Westby M, Gallardo ICA, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis Part one: introduction, and mind-body exercise programs. Clin Rehabil. 2017;31(5):582–595.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–1840.
    1. Clarke M, Mhuircheartaigh DA, N, Walsh G, Walsh J, Meldrum D, Intra-tester and inter-tester reliability of the MicroFET 3 hand-held dynamometer. Physiotherapy Practice and Research. 2011;32(1):13–18.
    1. Wang CY, Olson SL, Protas EJ. Test-retest strength reliability: hand-held dynamometry in community-dwelling elderly fallers. Arch Phys Med Rehabil. 2002;83(6):811–815.
    1. Taylor NF, Dodd KJ, Graham HK. Test-retest reliability of hand-held dynamometric strength testing in young people with cerebral palsy 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil. 2004;85(1):77–80.
    1. Vopat BG, Klinge SA, McClure PK, Fadale PD. The effects of fitness on the aging process. J Am Acad Orthop Surg. 2014;22(9):576–585.
    1. Lin PS, Hsieh CC, Cheng HS, Tseng TJ, Su SC. Association between Physical Fitness and Successful Aging in Taiwanese Older Adults. PLoS ONE. 2016;11(3):e0150389.
    1. Milanovic Z, Pantelic S, Trajkovic N, Sporis G, Kostic R, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. 2013;8:549–556.
    1. Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Activ. 1999;7(2):129–161.
    1. Rikli RE, Jones CJ. Senior fitness test manual: Human kinetics; 2013;11–22.
    1. Mishra P, Pandey CM, Singh U, Gupta A, Sahu C, Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth. 2019;22(1):67.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences: Lawrence Erlbaum Associates; 1988;1–17.
    1. Kotrlik JW, Williams HA, Jabor MK. Reporting and Interpreting Effect Size in Quantitative Agricultural Education Research. J Agric Educ. 2011;52(1):132–142.
    1. Pek J, Wong O, Wong A. How to address non-normality: A taxonomy of approaches, reviewed, and illustrated. Front Psychol. 2018;9:2104.
    1. Conover WJ, Iman RL. Analysis of covariance using the rank transformation. Biometrics. 1982;38(3):715–724.
    1. Lin C-Y, Lee H-W, Liu C-F, Lan S-J, Chu C-L. Effect of Tai Chi and Qigong on Functional Physical Fitness in Elderly. Sports & Exercise Research. 2018;20(1):52–63.
    1. Brosseau L, Taki J, Desjardins B, Thevenot O, Fransen M, Wells GA, MizusakiImoto A, Toupin-April K, Westby M, Alvarez Gallardo IC, et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs Clin Rehabil. 2017;31(5):612–624.
    1. Multanen J, Rantalainen T, Kautiainen H, Ahola R, Jamsa T, Nieminen MT, Lammentausta E, Hakkinen A, Kiviranta I, Heinonen A. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: a 12-month RCT. Osteoporos Int. 2017;28(4):1323–1333.
    1. Heiden TL, Lloyd DG, Ackland TR. Knee extension and flexion weakness in people with knee osteoarthritis: is antagonist cocontraction a factor? J Orthop Sports Phys Ther. 2009;39(11):807–815.
    1. van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, Dekker J. Decrease of Muscle Strength Is Associated With Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results From the Cohort Hip and Cohort Knee Study. Arch Phys Med Rehabil. 2014;95(10):1962–1968.
    1. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL: Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015, 1:CD004376.
    1. Latham N, Liu CJ. Strength training in older adults: the benefits for osteoarthritis. Clin Geriatr Med. 2010;26(3):445–459.
    1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet (London, England) 2019;393(10182):1745–1759.
    1. Lund H, Weile U, Christensen R, Rostock B, Downey A, Bartels EM, Danneskiold-Samsøe B, Bliddal H. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. J Rehabil Med. 2008;40(2):137–144.
    1. Lu M, Su Y, Zhang Y, Zhang Z, Wang W, He Z, Liu F, Li Y, Liu C, Wang Y, et al. Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis. Z Rheumatol. 2015;74(6):543–552.
    1. Wang TJ, Belza B, Elaine Thompson F, Whitney JD, Bennett K. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. J Adv Nurs. 2007;57(2):141–152.
    1. Yaacoub S, Khabsa J, El-Khoury R, El-Harakeh A, Lotfi T, Saad Z, Itani Z, Khamis AM, El Mikati I, Cuello-Garcia CA, et al. COVID-19 transmission during swimming-related activities: a rapid systematic review. BMC Infect Dis. 2021;21(1):1112.
    1. Simpson A, Pearson RG, Scammell B: Ten minutes ergometer rowing exercise increases pressure pain thresholds in high performance rowers. Annals of Sports Medicine and Research 2016, 3(7).
    1. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL: Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2015(1).
    1. Roemer K, Hortobagyi T, Richter C, Munoz-Maldonado Y, Hamilton S. Effect of BMI on knee joint torques in ergometer rowing. J Appl Biomech. 2013;29(6):763–768.
    1. Verma S: Comparing open kinetic chain with closed kinetic chain exercise on quadriceps strength and functional status of women with osteoarthritic knees. In: 2015.
    1. Verma S: Comparing open kinetic chain with closed kinetic chain exercise on quadriceps strength and functional status of women with osteoarthritic knees. Sports Medicine Journal/Medicina Sportivâ 2012, 8(4).
    1. Kellis E, Baltzopoulos V. Resistive eccentric exercise: effects of visual feedback on maximum moment of knee extensors and flexors. J Orthop Sports Phys Ther. 1996;23(2):120–124.
    1. Kim HJ, Kramer JF. Effectiveness of visual feedback during isokinetic exercise. J Orthop Sports Phys Ther. 1997;26(6):318–323.
    1. Naeemabadi M, Fazlali H, Najafi S, Dinesen B, Hansen J. Telerehabilitation for patients with knee osteoarthritis: a focused review of technologies and teleservices. JMIR Biomedical Engineering. 2020;5(1):e16991.
    1. Chen T, Or CK, Chen J. Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc. 2021;28(2):414–423.
    1. Byra J, Czernicki K. The effectiveness of virtual reality rehabilitation in patients with knee and hip osteoarthritis. J Clin Med. 2020;9(8):2639.
    1. Levinger P, Zeina D, Teshome AK, Skinner E, Begg R, Abbott JH. A real time biofeedback using Kinect and Wii to improve gait for post-total knee replacement rehabilitation: a case study report. Disabil Rehabil Assist Technol. 2016;11(3):251–262.
    1. Eichler S, Salzwedel A, Rabe S, Mueller S, Mayer F, Wochatz M, Hadzic M, John M, Wegscheider K, Völler H. The effectiveness of telerehabilitation as a supplement to rehabilitation in patients after total knee or hip replacement: randomized controlled trial. JMIR rehabilitation and assistive technologies. 2019;6(2):e14236.
    1. Naeemabadi MR, Dinesen BI, Andersen OK, Najafi S, Hansen J: Evaluating accuracy and usability of Microsoft Kinect sensors and wearable sensor for tele knee rehabilitation after knee operation. In: Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies, Biostec 2018; Biodevices 2018, 19–21 January 2018, Funchal, Madeira, Portugal: 2018. SCITEPRESS Digital Library: 128–135.
    1. Soper C, Hume PA. Towards an ideal rowing technique for performance. Sports Med. 2004;34(12):825–848.
    1. Hase K, Kaya M, Zavatsky AB, Halliday SE: Musculoskeletal Loads in Ergometer Rowing. Journal of Applied Biomechanics 2004, 20(3).

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