The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals

Flávia Yázigi, Margarida Espanha, Filomena Vieira, Stephen P Messier, Cristina Monteiro, Antonio P Veloso, Flávia Yázigi, Margarida Espanha, Filomena Vieira, Stephen P Messier, Cristina Monteiro, Antonio P Veloso

Abstract

Background: Aquatic exercise is recommended by the Osteoarthritis Research Society (OARSI), by the American College of Rheumatology (ACR) and by the European League Against Rheumatism (EULAR) as a nonpharmacological method of controlling the knee osteoarthritis (KOA) symptoms. Moreover, given that weight loss results in a reduction of the load that is exerted upon the knee during daily activities, obesity is also considered to be a modifiable risk factor for the development and or exacerbation of KOA. The implementation of an exercise based weight loss program may, however, itself be limited by the symptoms of KOA. The aquatic program against osteoarthritis (termed "PICO" in Portuguese) prioritizes the control of symptoms and the recovery of functionality, with an attendant increase in the patient's physical activity level and, consequently, metabolic rate. Our laboratory is assessing the effectiveness of 3 months of PICO on the symptoms of KOA, on physical function, on quality of life and on gait. In addition, PICO shall examine the effects of said exercise intervention on inflammatory biomarkers, psychological health, life style and body composition.

Methods/design: The trial is a prospective, single-blinded, randomized controlled trial, and involves 50 overweight and obese adults (BMI = 28-43.5 kg/m²; age 40-65 yrs) with radiographic KOA. The participants are randomly allocated into either an educational attention (control) group or an aquatic (exercise program) group. This paper describes the experimental protocol that is used in the PICO project.

Discussion: The PICO program shall provide insight into the effectiveness of an aquatic exercise program in the control of KOA symptoms and in the improvement of the quality of life. As such, they are likely to prove a useful reference to health professionals who intend to implement any kind of therapeutic intervention based around aquatic exercise.

Trial registration: NCT01832545.

Figures

Figure 1
Figure 1
PICO flowchart.

References

    1. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006;20:3–25. doi: 10.1016/j.berh.2005.09.007.
    1. DGS. Programa nacional contra as doenças reumáticas: circular normativa. Portugal: DGS; 2004. (Saúde DGd ed., vol. 12 DGCG edition).
    1. Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther. 2009;11:229. doi: 10.1186/ar2669.
    1. Issa SN, Sharma L. Epidemiology of osteoarthritis: an update. Curr Rheumatol Rep. 2006;8:7–15. doi: 10.1007/s11926-006-0019-1.
    1. Dieppe P. Osteoarthritis. Acta Orthop Scand Suppl. 1998. pp. 2–5.
    1. van der Kraan PM. Osteoarthritis year 2012 in review: biology. Osteoarthritis Cartilage. 2012;20:1447–1450. doi: 10.1016/j.joca.2012.07.010.
    1. Rai MF, Sandell LJ. Inflammatory mediators: tracing links between obesity and osteoarthritis. Crit Rev Eukaryot Gene Expr. 2011;21:131–142. doi: 10.1615/CritRevEukarGeneExpr.v21.i2.30.
    1. Williams F, Spector T. Osteoarthritis. Medicine. 2006. pp. 364–368.
    1. Winby CR, Lloyd DG, Besier TF, Kirk TB. Muscle and external load contribution to knee joint contact loads during normal gait. J Biomech. 2009;42:2294–2300. doi: 10.1016/j.jbiomech.2009.06.019.
    1. Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Rheum Dis Clin North Am. 2008;34:713–729. doi: 10.1016/j.rdc.2008.04.007.
    1. Cerejo R, Dunlop DD, Cahue S, Channin D, Song J, Sharma L. The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis Rheum. 2002;46:2632–2636. doi: 10.1002/art.10530.
    1. Chang A, Hayes K, Dunlop D, Song J, Hurwitz D, Cahue S, Sharma L. Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis Rheum. 2005;52:3515–3519. doi: 10.1002/art.21406.
    1. Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, Dieppe PA. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000;43:995–1000. doi: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>;2-1.
    1. Hunter DJ, Sharma L, Skaife T. Alignment and osteoarthritis of the knee. J Bone Joint Surg Am. 2009;91(1):85–89.
    1. Martin KR, Kuh D, Harris TB, Guralnik JM, Coggon D, Wills AK. Body mass index, occupational activity, and leisure-time physical activity: an exploration of risk factors and modifiers for knee osteoarthritis in the 1946 British birth cohort. BMC Musculoskelet Disord. 2013;14:219. doi: 10.1186/1471-2474-14-219.
    1. The global epidemic: IASO/IOTF analysis.
    1. Bullo M, Garcia-Lorda P, Megias I, Salas-Salvado J. Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression. Obes Res. 2003;11:525–531. doi: 10.1038/oby.2003.74.
    1. Scharstuhl A, Glansbeek HL, van Beuningen HM, Vitters EL, van der Kraan PM, van den Berg WB. Inhibition of endogenous TGF-beta during experimental osteoarthritis prevents osteophyte formation and impairs cartilage repair. J Immunol. 2002;169:507–514.
    1. Mobasheri A. Osteoarthritis year 2012 in review: biomarkers. Osteoarthritis Cartilage. 2012;20:1451–1464. doi: 10.1016/j.joca.2012.07.009.
    1. Bitton R. The economic burden of osteoarthritis. Am J Manag Care. 2009;15:S230–235.
    1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26:355–369. doi: 10.1016/j.cger.2010.03.001.
    1. Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, Fang F, Schwartz TA, Abbate LM, Callahan LF. et al.Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston county osteoarthritis project. J Rheumatol. 2007;34:172–180.
    1. Farr JN, Going SB, Lohman TG, Rankin L, Kasle S, Cornett M, Cussler E. Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Arthritis Rheum. 2008;59:1229–1236. doi: 10.1002/art.24007.
    1. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–1727. doi: 10.1001/jama.288.14.1723.
    1. Richmond J, Hunter D, Irrgang J, Jones MH, Levy B, Marx R, Snyder-Mackler L, Watters WC 3rd, Haralson RH 3rd, Turkelson CM. et al.Treatment of osteoarthritis of the knee (nonarthroplasty) J Am Acad Orthop Surg. 2009;17:591–600.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M. et al.OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–162. doi: 10.1016/j.joca.2007.12.013.
    1. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64:465–474.
    1. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P. et al.EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing committee for international clinical studies including therapeutic trials (ESCISIT) Ann Rheum Dis. 2003;62:1145–1155. doi: 10.1136/ard.2003.011742.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M. 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. Osteoarthritis Cartilage. 2010;18:476–499. doi: 10.1016/j.joca.2010.01.013.
    1. Helmark IC, Mikkelsen UR, Borglum J, Rothe A, Petersen MC, Andersen O, Langberg H, Kjaer M. Exercise increases interleukin-10 levels both intraarticularly and peri-synovially in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Res Ther. 2010;12:R126. doi: 10.1186/ar3064.
    1. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14:4–9. doi: 10.1016/j.jsams.2010.08.002.
    1. Bosomworth NJ. Exercise and knee osteoarthritis: benefit or hazard? Can Fam Physician. 2009;55:871–878.
    1. Roddy E, Zhang W, Doherty M, Arden NK, Barlow J, Birrell F, Carr A, Chakravarty K, Dickson J, Hay E. et al.Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee–the MOVE consensus. Rheumatology (Oxford) 2005;44:67–73. doi: 10.1093/rheumatology/keh399.
    1. Mundermann A, Dyrby CO, Hurwitz DE, Sharma L, Andriacchi TP. Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. Arthritis Rheum. 2004;50:1172–1178. doi: 10.1002/art.20132.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M. et al.OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007;15:981–1000. doi: 10.1016/j.joca.2007.06.014.
    1. Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R, Danneskiold-Samsoe B. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2007;17(4):CD005523.
    1. Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther. 2007;87:32–43. doi: 10.2522/ptj.20060006.
    1. Lim JY, Tchai E, Jang SN. Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. PM R. 2010;2:723–731. doi: 10.1016/j.pmrj.2010.04.004. quiz 793.
    1. Wang TJ, Lee SC, Liang SY, Tung HH, Wu SF, Lin YP. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. J Clin Nurs. 2011;20:2609–2622. doi: 10.1111/j.1365-2702.2010.03675.x.
    1. Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. J Strength Cond Res. 2001;15:337–340.
    1. Tsourlou T, Benik A, Dipla K, Zafeiridis A, Kellis S. The effects of a twenty-four-week aquatic training program on muscular strength performance in healthy elderly women. J Strength Cond Res. 2006;20:811–818.
    1. Driver S, O’Connor J, Lox C, Rees K. Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury. Brain Inj. 2004;18:847–859. doi: 10.1080/02699050410001671856.
    1. Templeton MS, Booth DL, O’Kelly WD. Effects of aquatic therapy on joint flexibility and functional ability in subjects with rheumatic disease. J Orthop Sports Phys Ther. 1996;23:376–381. doi: 10.2519/jospt.1996.23.6.376.
    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;57:141–152. doi: 10.1111/j.1365-2648.2006.04102.x.
    1. Liebs TR, Herzberg W, Ruther W, Haasters J, Russlies M, Hassenpflug J. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil. 2012;93:192–199. doi: 10.1016/j.apmr.2011.09.011.
    1. Valtonen A, Poyhonen T, Sipila S, Heinonen A. Maintenance of aquatic training-induced benefits on mobility and lower-extremity muscles among persons with unilateral knee replacement. Arch Phys Med Rehabil. 2011;92:1944–1950. doi: 10.1016/j.apmr.2011.07.191.
    1. Escalante Y, Saavedra JM, Garcia-Hermoso A, Silva AJ, Barbosa TM. Physical exercise and reduction of pain in adults with lower limb osteoarthritis: a systematic review. J Back Musculoskelet Rehabil. 2010;23:175–186.
    1. Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:745–755. doi: 10.1016/j.apmr.2008.12.011.
    1. Lee HY. Comparison of effects among Tai-Chi exercise, aquatic exercise, and a self-help program for patients with knee osteoarthritis. Taehan Kanho Hakhoe Chi. 2006;36:571–580.
    1. Aquatic physical therapy: running in water decreases stress on the body. J Orthop Sports Phys Ther. 2012;42:445.
    1. Verhagen AP, Cardoso JR, Bierma-Zeinstra SM. Aquatic exercise & balneotherapy in musculoskeletal conditions. Best Pract Res Clin Rheumatol. 2012;26:335–343. doi: 10.1016/j.berh.2012.05.008.
    1. Ariyoshi M, Sonoda K, Nagata K, Mashima T, Zenmyo M, Paku C, Takamiya Y, Yoshimatsu H, Hirai Y, Yasunaga H. et al.Efficacy of aquatic exercises for patients with low-back pain. Kurume Med J. 1999;46:91–96. doi: 10.2739/kurumemedj.46.91.
    1. Bacon MC, Nicholson C, Binder H, White PH. Juvenile rheumatoid arthritis: aquatic exercise and lower-extremity function. Arthritis Care Res. 1991;4:102–105. doi: 10.1002/art.1790040207.
    1. Hall J, Grant J, Blake D, Taylor G, Garbutt G. Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis. Physiother Res Int. 2004;9:59–73. doi: 10.1002/pri.303.
    1. Kelly M, Darrah J. Aquatic exercise for children with cerebral palsy. Dev Med Child Neurol. 2005;47:838–842. doi: 10.1017/S0012162205001775.
    1. Kargarfard M, Dehghadani M, Ghias R. The effect of aquatic exercise therapy on muscle strength and Joint’s range of motion in hemophilia patients. Int J Prev Med. 2013;4:50–56.
    1. Kallberg J. Aquatic therapy brings relief: arthritis sufferers go back to the future to achieve freedom from pain, courtesy of technological advances in an old remedy. Provider. 2013;39:35–37.
    1. Cantarero-Villanueva I, Fernandez-Lao C, Cuesta-Vargas AI, Del Moral-Avila R, Fernandez-de-Las-Penas CC, Arroyo-Morales M. The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized clinical trial deep water aquatic exercise in cancer survivors. Arch Phys Med Rehabil. 2012;94(2):221–230.
    1. Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R. Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial. Br J Sports Med. 2012;46:656–661. doi: 10.1136/bjsports-2011-090009.
    1. DeMaere JM, Ruby BC. Effects of deep water and treadmill running on oxygen uptake and energy expenditure in seasonally trained cross country runners. J Sports Med Phys Fitness. 1997;37:175–181.
    1. Martel GF, Harmer ML, Logan JM, Parker CB. Aquatic plyometric training increases vertical jump in female volleyball players. Med Sci Sports Exerc. 2005;37:1814–1819. doi: 10.1249/01.mss.0000184289.87574.60.
    1. Reilly T, Ekblom B. The use of recovery methods post-exercise. J Sports Sci. 2005;23:619–627. doi: 10.1080/02640410400021302.
    1. Alberton CL, Cadore EL, Pinto SS, Tartaruga MP, da Silva EM, Kruel LF. Cardiorespiratory, neuromuscular and kinematic responses to stationary running performed in water and on dry land. Eur J Appl Physiol. 2011;111:1157–1166. doi: 10.1007/s00421-010-1747-5.
    1. Yazigi F, Pinto S, Colado J, Escalante Y, Armada-Da-Silva P, Brasil R, Alves F. The cadence and water temperature effect on physiological responses during water cycling. European Journal of Sport Science. 2013. pp. 1–7.
    1. Water exercise for arthritis. Low-impact fitness. Mayo Clin Health Lett. 2003;21:4–5.
    1. Broman G, Quintana M, Engardt M, Gullstrand L, Jansson E, Kaijser L. Older women’s cardiovascular responses to deep-water running. J Aging Phys Act. 2006;14:29–40.
    1. Brown SP, Chitwood LF, Beason KR, McLemore DR. Physiological correlates with perceived exertion during deep water running. Percept Mot Skills. 1996;83:155–162. doi: 10.2466/pms.1996.83.1.155.
    1. Butts NK, Tucker M, Greening C. Physiologic responses to maximal treadmill and deep water running in men and women. Am J Sports Med. 1991;19:612–614. doi: 10.1177/036354659101900610.
    1. Chu KS, Rhodes EC. Physiological and cardiovascular changes associated with deep water running in the young. Possible implications for the elderly. Sports Med. 2001;31:33–46. doi: 10.2165/00007256-200131010-00003.
    1. Triplett NT, Colado JC, Benavent J, Alakhdar Y, Madera J, Gonzalez LM, Tella V. Concentric and impact forces of single-leg jumps in an aquatic environment versus on land. Med Sci Sports Exerc. 2009;41:1790–1796. doi: 10.1249/MSS.0b013e3181a252b7.
    1. Phillips VK, Legge M, Jones LM. Maximal physiological responses between aquatic and land exercise in overweight women. Med Sci Sports Exerc. 2008;40:959–964. doi: 10.1249/MSS.0b013e318164d0e0.
    1. Aquatic Exercise Association. Aquatic fitness professional manual 5 edn. Nokomis, FL; 2006.
    1. Foundation A. Arthritis foundation YMCA aquatic program (AFYAP) and AFYAP PLUS instructor’s guides 4th edn. The Arthritis Foundation: Atlanta; 2002.
    1. Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Med Clin North Am. 2009;93:145–159. doi: 10.1016/j.mcna.2008.09.011. xi-xii.
    1. Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D. et al.The American college of rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–514. doi: 10.1002/art.1780340502.
    1. American College of Sports Medicine (ACSM) ACSM’s guidelines for exercise testing and prescription. 8. Lippincott: Williams & Wilkins; 2009.
    1. Messier SP, Legault C, Mihalko S, Miller GD, Loeser RF, DeVita P, Lyles M, Eckstein F, Hunter DJ, Williamson JD, Nicklas BJ. The intensive diet and exercise for arthritis (IDEA) trial: design and rationale. BMC Musculoskelet Disord. 2009;10:93. doi: 10.1186/1471-2474-10-93.
    1. Batterham SI, Heywood S, Keating JL. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord. 2011;12:123. doi: 10.1186/1471-2474-12-123.
    1. Silva M, Santos T, Coutinho S, Marcelino M, Vieira P, Tomás R, Carraça E, Minderico C, Sardinha L, Teixeira P. O programa “PESO COMUNITÁRIO. Revista de Informação e Divulgação Científica sobre Doenças do Comportamento Alimentar. 2008;5:1–12.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502. doi: 10.1136/ard.16.4.494.
    1. Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrar JT, Galer BS. et al.Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106:337–345. doi: 10.1016/j.pain.2003.08.001.
    1. Mendoza T, Mayne T, Rublee D, Cleeland C. Reliability and validity of a modified brief pain inventory short form in patients with osteoarthritis. Eur J Pain. 2006;10:353–361. doi: 10.1016/j.ejpain.2005.06.002.
    1. Ferreira-Valente MA, Pais Ribeiro JL, Jensen MP. Further validation of a Portuguese version of the brief pain inventory interference scale. Clínica y Salud. 2012;23:89–96.
    1. Azevedo LF, Pereira AC, Dias C, Agualusa L, Lemos L, Romão J, Castro-Lopes JM. Tradução, adaptação cultural e estudo multicêntrico de validação de instrumentos para rastreio e avaliação do impacto da dor crónica. Dor. 2007;15:6–37.
    1. Roos EM, Lohmander LS. The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi: 10.1186/1477-7525-1-64.
    1. Goncalves RS, Cabri J, Pinheiro JP, Ferreira PL. Cross-cultural adaptation and validation of the Portuguese version of the knee injury and osteoarthritis outcome score (KOOS) Osteoarthritis Cartilage. 2009;17:1156–1162. doi: 10.1016/j.joca.2009.01.009.
    1. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1171–1178.
    1. Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11. doi: 10.1186/1477-7525-6-11.
    1. Ferreira P. Avaliação psicométrica e adaptação cultural e linguística de instrumentos de medição em saúde: princípios metodológicos gerais. Centro de Estudos e Investigação em Saúde da Universidade de Coimbra; 1998.
    1. Ferreira P. Criação da versão Portuguesa do SF-36 - parte II - testes de validação. Acta Med Port. 2000;13:119–127.
    1. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597. doi: 10.1207/s15327752jpa6703_13.
    1. Campos RC, Goncalves B. The Portuguese version of the beck depression inventory-II (BDI-II) preliminary psychometric data with two nonclinical samples. Eur J Psychol Assess. 2011;27:258–264. doi: 10.1027/1015-5759/a000072.
    1. Beck AT, Steer RA. Internal consistencies of the original and revised beck depression inventory. J Clin Psychol. 1984;40:1365–1367. doi: 10.1002/1097-4679(198411)40:6<1365::AID-JCLP2270400615>;2-D.
    1. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. Am J Respir Crit Care Med. 2003;167:1287.
    1. Beriault K, Carpentier AC, Gagnon C, Menard J, Baillargeon JP, Ardilouze JL, Langlois MF. Reproducibility of the 6-minute walk test in obese adults. Int J Sports Med. 2009;30:725–727. doi: 10.1055/s-0029-1231043.
    1. Goncalves RS, Pinheiro JP, Cabri J. Evaluation of potentially modifiable physical factors as predictors of health status in knee osteoarthritis patients referred for physical therapy. Knee. 2012;19:373–379. doi: 10.1016/j.knee.2011.05.010.
    1. Bennell K, Dobson F, Hinman R. Measures of physical performance assessments: self-paced walk test (SPWT), stair climb test (SCT), Six-minute walk test (6MWT), chair stand test (CST), timed Up & Go (TUG), sock test, lift and carry test (LCT), and car task. Arthritis Care Res (Hoboken) 2011;63(11):S350–370.
    1. Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, Newman AB. The 6-min walk test: a quick measure of functional status in elderly adults. Chest. 2003;123:387–398. doi: 10.1378/chest.123.2.387.
    1. Escalante Y, Garcia-Hermoso A, Saavedra JM. Effects of exercise on functional aerobic capacity in lower limb osteoarthritis: a systematic review. J Sci Med Sport. 2011;14:190–198. doi: 10.1016/j.jsams.2010.10.004.
    1. Schlenk EA, Lias JL, Sereika SM, Dunbar-Jacob J, Kwoh CK. Improving physical activity and function in overweight and obese older adults with osteoarthritis of the knee: a feasibility study. Rehabil Nurs. 2011;36:32–42. doi: 10.1002/j.2048-7940.2011.tb00063.x.
    1. Jones CJ, Rikli RE, Max J, Noffal G. The reliability and validity of a chair sit-and-reach test as a measure of hamstring flexibility in older adults. Res Q Exerc Sport. 1998;69:338–343. doi: 10.1080/02701367.1998.10607708.
    1. Rikli RE, Jones CJ. The development and validation of a functional fitness test for community-residimg older adults. J Aging Phys Act. 1999;7:129–161.
    1. Bohannon RW. Sit-to-stand test for measuring performance of lower extremity muscles. Percept Mot Skills. 1995;80:163–166. doi: 10.2466/pms.1995.80.1.163.
    1. Bohannon RW. Test-retest reliability of the five-repetition sit-to-stand test: a systematic review of the literature involving adults. J Strength Cond Res. 2011;25:3205–3207. doi: 10.1519/JSC.0b013e318234e59f.
    1. Rejeski W, Miller M, Foy C, Messier S, Rapp S. Self-efficacy and the progression of functional limitations and self-reported disability in older adults with knee pain. Journal of Gerontology: Social Sciences. 2001;56B:S261–S265.
    1. Rejeski W, Ettinger W, Schumaker S, James P, Burns R, Elam J. Assessing performance-related disability in patients with knee osteoarthritis. Osteoarthritis Cartilage. 1995;3:157–167. doi: 10.1016/S1063-4584(05)80050-0.
    1. Rejeski W, Craven T, Ettinger W, McFarlane M, Shumaker S. Self-efficacy and pain in disability with osteoarthritis of the knee. J Gerontol Psychol Sci. 1996;51B:P24–P29. doi: 10.1093/geronb/51B.1.P24.
    1. Miller M, Rejeski W, Messier S, Loeser R. Modifiers of change in physical functioning in older adults with knee pain: the observational arthritis study in seniors (OASIS) Arthritis Care Res. 2001;45:331–339. doi: 10.1002/1529-0131(200108)45:4<331::AID-ART345>;2-6.
    1. Messier S, Glasser J, Ettinger W, Craven T, Miller M. Declines in strength and balance in older adults with chronic knee pain: A 30 month longitudinal, observational study. Arthritis & Rheumatism. 2002;47:141–148. doi: 10.1002/art.10339.
    1. Brandt K, Heilman D, Slemenda C, Katz B, Mazzuca S, Braunstein E, Byrd D. A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. J Rheumatol. 2000;27:1937–1946.
    1. Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N, Torner J, Cooke TD, Hietpas J, Lynch J, Nevitt M. Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis. 2010;69:1940–1945. doi: 10.1136/ard.2010.129742.
    1. Barbat-Artigas S, Rolland Y, Zamboni M, Aubertin-Leheudre M. How to assess functional status: a new muscle quality index. J Nutr Health Aging. 2012;16:67–77. doi: 10.1007/s12603-012-0004-5.
    1. Deforche B, Lefevre J, De Bourdeaudhuij I, Hills AP, Duquet W, Bouckaert J. Physical fitness and physical activity in obese and nonobese Flemish youth. Obes Res. 2003;11:434–441. doi: 10.1038/oby.2003.59.
    1. Baptista F, Silva A, Marques E, Mota J, Santos R, Vale S, Ferreira J, Raimundo A, Moreira H. Observatorio nacional da actividade física e do desporto: livro verde da aptidão física. Lisbon, Portugal: Instituto do Desporto de Portugal (IDP); 2011. IDP.
    1. Marfell-Jones M, Olds T, Stewart A, Lindsay Carter JE. International standards for anthropometric assessment. ISAK.: Potchefstroom; 2006.
    1. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual champaing. Human Kinetics Brooks: Illions; 1988.
    1. Pheasant S, Haslegrave CM. Bodyspace anthropometry, ergonomics, and the design of work. Boca Raton, FL: Taylor and Francis; 2006.
    1. Riserus U, Arnlov J, Brismar K, Zethelius B, Berglund L, Vessby B. Sagittal abdominal diameter is a strong anthropometric marker of insulin resistance and hyperproinsulinemia in obese men. Diabetes Care. 2004;27:2041–2046. doi: 10.2337/diacare.27.8.2041.
    1. Winter D. The biomechanics and motor control of human gait: normal, elderly and pathological. Ontario: University of Waterloo Press; 1991.
    1. Block JA, Shakoor N. The biomechanics of osteoarthritis: implications for therapy. Curr Rheumatol Rep. 2009;11:15–22. doi: 10.1007/s11926-009-0003-7.
    1. Messier SP. Osteoarthritis of the knee and associated factors of age and obesity: effects on gait. Med Sci Sports Exerc. 1994;26:1446–1452.
    1. Sharma L, Hurwitz DE, Thonar EJ, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum. 1998;41:1233–1240. doi: 10.1002/1529-0131(199807)41:7<1233::AID-ART14>;2-L.
    1. Kumar D, Manal KT, Rudolph KS. Knee joint loading during gait in healthy controls and individuals with knee osteoarthritis. Osteoarthritis Cartilage. 2013;21:298–305. doi: 10.1016/j.joca.2012.11.008.
    1. Teichtahl AJ, Wluka AE, Morris ME, Davis SR, Cicuttini FM. The relationship between the knee adduction moment and knee pain in middle-aged women without radiographic osteoarthritis. J Rheumatol. 2006;33:1845–1848.
    1. Thorp LE, Sumner DR, Block JA, Moisio KC, Shott S, Wimmer MA. Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. Arthritis Rheum. 2006;54:3842–3849. doi: 10.1002/art.22247.
    1. Thorp LE, Sumner DR, Wimmer MA, Block JA. Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. Arthritis & Rheumatism-Arthritis Care & Research. 2007;57:1254–1260. doi: 10.1002/art.22991.
    1. Yamada H, Koshino T, Sakai N, Saito T. Hip adductor muscle strength in patients with varus deformed knee. Clin Orthop Relat Res. 2001. pp. 179–185.
    1. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Rutten A, Abu-Omar K. Prevalence of physical activity in the European Union. Soz Praventivmed. 2004;49:281–289.
    1. Rutten A, Abu-Omar K. Perceptions of environmental opportunities for physical activity in the European Union. Soz Praventivmed. 2004;49:310–317.
    1. Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act. 2011;8:115. doi: 10.1186/1479-5868-8-115.
    1. Guidelines for data processing and analysis of the international physical activity questionnaire (IPAQ)– short and long forms. vol. 2006. , 2005.
    1. Wadden TA, Foster GD. Weight and lifestyle inventory (WALI) Obesity (Silver Spring) 2006;14(2):99S–118S.
    1. Teixeira P, Silva M. Repensar o PESO: princípios e métodos testados para controlar o peso. 2009.

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