An 8-Week Neuromuscular Exercise Program for Patients With Mild to Moderate Knee Osteoarthritis: A Case Series Drawn From a Registered Clinical Trial

Abstract

Objective: To describe the feasibility of a neuromuscular exercise (NEMEX) program in patients with mild to moderate knee osteoarthritis (KOA).

Background: Neuromuscular exercise has been increasingly used in patients with osteoarthritis to achieve sensorimotor control and improved daily function.

Treatment: A study of the first 23 physically active patients (11 men, 12 women; age range = 48-70 years) who had mild to moderate KOA and were undergoing an 8-week, twice-weekly program, consisting of 11 exercises with 3 to 4 levels of difficulty, as part of an ongoing randomized controlled trial. The level of difficulty was noted for each exercise and session. We recorded exertion, pain, adverse events, and adherence. For the 18 patients who participated in 6 or more sessions, a progression of at least 1 level of difficulty (out of 3-4) was observed in half or more of the exercises. However, few patients progressed to jumping activities. Exertion ranged from light to very heavy. Four patients reported a clinically relevant increase in short-term pain after 1 to 2 of the 16 scheduled sessions. No adverse musculoskeletal events were reported. Notably, 3 patients dropped out due to increased (n = 2) or persisting (n = 1) knee pain. However, their pain ratings did not show worsening symptoms.

Uniqueness: This NEMEX-KOA program was designed for physically active middle-aged patients with mild to moderate KOA; therefore, it involved exercises and difficulty levels that were more challenging than a previously described NEMEX program for patients eligible for total joint replacement.

Conclusions: In patients with baseline mild to severe pain with activity, the NEMEX-KOA program was feasible. Progression was achieved with few incidents of clinically relevant increases in pain and no adverse events. However, jumping activities were not feasible. These findings hold promise for investigating the efficacy of the NEMEX-KOA program in individuals with mild to moderate KOA.

Keywords: pain management; physiotherapy; training.

Figures

Figure 1.

Level of difficulty at which each exercise was performed at the first, halfway, and last exercise sessions. Neuromuscular exercises focused on strength gain: (A) squat, (B) lunge, (C) step-up, and (D) kettlebell swing; functional performance: (E) weight transfer, (F) cloth under foot, (G) mini trampoline, (H) cable and elastics band; postural stability: (I) pelvic lift and (J) side-lying jumping jacks; and some levels containing jumps: (G) mini trampoline, (K) limping cross, (A) squat, levels 2 and 4, (C) step-up, levels 3–4, and (E) weight transfer, level 3.

Figure 1. (Continued from previous page.)

The numbers (0–3/4) from the center to the circumference corresponds to the level of difficulty, with 1 being the lowest. The numbers (1–23) around the circumference refer to the 23 individual patients. The light gray area indicates the level of difficulty for the patients at the first session. The black line indicates the level of difficulty for the patients at the halfway (median) session of the attended sessions. The dark gray area indicates the level of difficulty for the patients at the last session. Patients with identifications 1–5 attended 2–5 exercise sessions and those with identifications 6–23 attended 6–16 sessions.

Figure 2.

Perceived exertion after the first and last exercise sessions. The numbers (0–10) from the center to the circumference indicate exertion levels, with 0 representing nothing at all and 10 representing extremely strong (almost max). The numbers (1–23) around the circumference refer to the 23 individual patients. The light gray area indicates the perceived exertion level for the patients at the first session. The dark gray area indicates the exertion level for the patients at the last session. Patients with identifications 1–5 attended 2–5 exercise sessions and those with identifications 6–23 attended 6–16 sessions.