Comparison of whole-body vibration training and quadriceps strength training on physical function and neuromuscular function of individuals with knee osteoarthritis: A randomised clinical trial

Association Between Prescribed Dosage of Resistance Exercise and Change in Pain and Physical Function in Knee Osteoarthritis: A Systematic Review With Meta-Regression

OBJECTIVE

To assess whether there is an association between total prescribed dosage of resistance exercise (volume, frequency, intensity, and duration) and change in pain and physical function in individuals with knee osteoarthritis (OA).

METHOD

A systematic review with meta-regression was conducted, searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials until December 11, 2024. We included randomised controlled trials that compared resistance exercise for knee OA with non-exercise interventions. Meta-regression examined the association between total prescribed exercise dosage (volume × frequency × intensity × duration of the intervention) and standardised mean differences (SMDs) for change in pain and physical function. Covariates were included to attempt to reduce between-study heterogeneity.

RESULTS

Analysis of 14 trials (N = 1274) found no association between total prescribed resistance exercise dosage and changes in pain (slope coefficient: < 0.01 on a 0-100 scale [95% CI: < - 0.01 to < 0.01]; p = 0.18) or physical function (slope coefficient: < 0.01 on a 0-100 scale [95% CI: < - 0.01 to < 0.01]; p = 0.15). Heterogeneity was substantial (I2 = 73%-97%) and many trials were of unclear/high risk of bias.

CONCLUSION

No association was found between the total prescribed dosage of resistance exercise and changes in pain or function in individuals with knee OA. However, due to the limited number of trials, high heterogeneity, and overall low quality of studies, findings should be interpreted with caution.

The Effectiveness of closed kinetic chain exercises in individuals with knee osteoarthritis: A systematic review and meta-analysis

INTRODUCTION

The aims of this review was to investigate the effectiveness of closed kinetic chain exercise (CKCE) on pain, function, and proprioception in individuals with knee osteoarthritis (OA).

METHODS

Nine databases were searched up to December 2023. Randomized controlled trials (RCTs) examining the effects of CKCE in individuals with knee OA were included. The methodological quality was assessed using the PEDro scale, and the level of evidence was evaluated with the GRADE system. A random-effects meta-analysis was conducted to assess differences between treatment groups for the primary outcomes (pain and function). Effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs).

RESULTS

A total of 24 studies were included in the descriptive analysis, and 18 studies were included in the quantitative analysis (meta-analysis). The meta-analysis results indicated that CKCE treatment led to greater improvements in pain (SMD = -0.76; 95% CI: -1.51, -0.01) and function (SMD = -1.25; 95% CI: -1.88, -0.62) compared to no treatment. A subgroup meta-analysis showed that the combined treatment of CKCE and conventional physical therapy (CPT) resulted in greater improvements in pain (SMD = -1.18; 95% CI: -1.70, -0.67) and function (SMD = -1.27; 95% CI: -1.79, -0.75) compared to CPT alone. The risk of bias assessment revealed that two studies were of low quality, nine were of fair quality, and the remaining 13 were of high quality. The GRADE system indicated a low quality of evidence for the effects of CKCE on both pain and function.

CONCLUSION

While CKCE shows promise in reducing pain and improving function in individuals with knee OA, the quality of evidence is considered low according to the GRADE system. Further high-quality RCTs with larger sample sizes are needed to confirm the effectiveness of CKCE in managing knee OA.

Relationship Between Number of Different Lower-Limb Resistance Exercises Prescribed in a Program and Exercise Outcomes in People With Knee Osteoarthritis: A Systematic Review With Meta-Regression

OBJECTIVE

We determine whether there is a relationship between the number of different lower-limb resistance exercises prescribed in a program and outcomes for people with knee osteoarthritis.

METHODS

We used a systematic review with meta-regression. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024. We included randomized controlled trials that evaluated land-based resistance exercise for knee osteoarthritis compared with nonexercise interventions. We conducted meta-regressions between number of different exercises prescribed and standardized mean differences (SMDs) for pain and function. Covariates (intervention duration, frequency per week, use of resistance exercise machine[s], and comparator type) were applied to attempt to reduce between-study heterogeneity.

RESULTS

Forty-four trials (3,364 participants) were included. The number of resistance exercises ranged from 1 to 12 (mean ± SD 5.0 ± 3.0). Meta-regression showed no relationship between the number of prescribed exercises and change in pain (slope coefficient: -0.04 SMD units [95% confidence interval {95% CI} -0.14 to 0.05]) or self-reported function (SMD -0.04 [95% CI -0.12 to 0.05]). There was substantial heterogeneity and evidence of publication bias. However, even after removing 31 trials that had overall unclear/high risk of bias, there was no change in relationships.

CONCLUSION

There was no relationship between the number of different lower-limb resistance exercises prescribed in a program and change in knee pain or self-reported function. However, given that we were unable to account for all differences in program intensity, progression, and adherence, as well as the heterogeneity and overall low quality of included studies, our results should be interpreted with caution.

Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta-Analysis

OBJECTIVE

We wanted to determine if higher compliance with American College of Sports Medicine (ACSM) exercise prescription guidelines influences exercise outcomes in knee osteoarthritis (OA).

METHODS

We conducted a systematic review. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024, for randomized controlled trials evaluating resistance and/or aerobic exercise for knee OA. Interventions were classified as higher compliance (meeting ≥60% of ACSM guideline recommendations for frequency, intensity, and duration) or lower compliance (meeting <60% of recommendations). Effects on pain and function were evaluated via meta-analysis, stratified by compliance.

RESULTS

Twenty-five trials (3,290 participants) evaluated combined resistance and aerobic programs, with no differences in outcomes between those with higher and lower compliance (standardized mean difference [SMD] pain: -0.38 [95% confidence interval (CI) -0.59 to -0.17] vs -0.31 [95% CI -0.45 to -0.16], respectively; SMD function: -0.43 [95% CI -0.64 to -0.21] vs -0.36 [95% CI -0.58 to -0.14]). Sixty-six trials (5,231 participants) evaluated resistance exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.60 [95% CI -0.81 to -0.39] vs -0.93 [95% CI -1.27 to -0.59]; SMD function: -0.64 [95% CI -0.83 to -0.44] vs -0.85 [95% CI -1.20 to -0.49]). Twelve trials (958 participants) evaluated aerobic exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.79 [95% CI -1.20 to -0.38] vs -1.00 [95% CI -2.52 to 0.53]; SMD function: -0.83 [95% CI -1.27 to -0.38] vs -0.76 [95% CI -2.02 to 0.50]).

CONCLUSION

Higher or lower compliance with ACSM exercise prescription guidelines did not influence exercise outcomes. Given there was substantial heterogeneity and many publications were at risk of bias, our results should be interpreted with caution.

Acute whole-body vibration as a recovery strategy did not alter the content of gluteus medius monocarboxylate-transporters, lactatemia, and acidosis induced by intense exercise in horses

Introduction

Several studies have explored alternatives to enhance the performance, health, and safety of sports horses. One promising method involves the use of vibrating platforms (VP), which offer passive exercise stimulation via mechanical oscillations distributed throughout the body. This type of exercise is referred to as whole-body vibration (WBV) and is an emerging strategy for accelerating muscle recovery. This study examined the dynamics of proteins responsible for transporting monocarboxylates (MCT1 and MCT4), and their relationship with lactatemia and acid-base balance in connection with WBV recovery following intense treadmill exercise in horses.

Methods

Eight crossbred horses underwent the standardized exercise test on the treadmill to determine the velocity corresponding to the lactate threshold. This velocity was used to prescribe the external load of the acute intense exercise bout (AIEB), which was performed to recruit rapidly fatigable type II muscle fibers and induce hyperlactatemia and metabolic acidosis. The horses were assigned to three experimental groups in a crossover design, with a 7-day washout period. The treadmill group (TG) actively recovered through low-intensity treadmill walking. The WBV group (WBVG) followed a stepwise recovery protocol on VP, with each step lasting 2 min and the frequencies decreasing in a specific order: 76, 66, 55, 46, and 32 Hz. The sham group (SG) was designated for horses with the VP turned off. All groups experienced a uniform recovery strategy duration of 10 min. Heart rate (HR), rectal temperature (RT), lactatemia, glycemia, acid-base status and electrolytes, strong ion difference (SID), and muscle monocarboxylate transporters (MCT1 and MCT4), were assessed.

Results

AIEB induced positive chronotropic effects, hyperlactatemia and moderate metabolic acidosis in all experimental groups. All groups also showed transitory hyperthermia, hyperglycemia, hypernatremia, hyperchloremia, hyperkalemia and SID reduction. HR was higher in TG than in the WBVG and SG immediately after the recovery procedures. Between the groups, there was no change in RT, lactatemia, glycemia and MCT1 and MCT4 content. Regardless of groups, the MCT4 content decreased 3 and 6 h after recovery strategies.

Discussion

It was concluded that a single whole-body vibration session did not enhance recovery of lactatemia or acid-base balance in horses after intense treadmill exercise.

Effects of whole-body vibration training as an adjunct to conventional rehabilitation exercise on pain, physical function and disability in knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Knee osteoarthritis (KOA) is a prevalent degenerative joint condition that impairs mobility and quality of life. While whole-body vibration training (WBVT) shows promise as an adjunct to conventional KOA rehabilitation, its efficacy remains unclear due to inconsistent clinical evidence.

OBJECTIVE

To elucidate the combined effects of WBVT and rehabilitation exercise on pain, physical function, and disability in KOA management through a systematic review and meta-analysis.

METHODS

A comprehensive search was conducted across eight electronic databases (PubMed, Web of Science, Embase, PEDro, SPORTDiscus, Scopus, ScienceDirect, and China National Knowledge Infrastructure) up to February 2024. Inclusion criteria were (i) randomized controlled trials comparing combined WBVT and rehabilitation exercise versus rehabilitation alone in KOA (ii) reported clinical outcomes (iii) human studies, and (iv) publications in English or Chinese. Trial quality was assessed using the PEDro scale and Cochrane risk-of-bias tool. The meta-analysis employed random-effects models in Review Manager 5.3 to account for heterogeneity, supported by sensitivity analyses for robustness and subgroup analyses on WBVT frequency effects.

RESULTS

Sixteen RCTs comprising 589 participants were included. The systematic review found that WBVT combined with conventional rehabilitation significantly reduced pain and improved physical function in KOA patients. The meta-analysis quantified these effects, showing that WBVT significantly (i) reduced knee pain (MD = -0.43, 95% CI [-0.70, -0.16], p = 0.002), with greater reductions observed from high-frequency WBVT, and (ii) increased isokinetic knee peak torque compared to rehabilitation exercise alone. No significant differences were found in balance, functional mobility, and disability outcomes. Sensitivity analysis of high-quality trials supported these results. However, the heterogeneity among studies and variations in control group interventions warrant cautious interpretation.

CONCLUSION

WBVT seems to be effective in reducing pain and enhancing muscle strength in KOA patients when used in conjunction with conventional rehabilitation. Future high-quality RCTs must standardize WBVT protocols, emphasize long-term follow-up, and refine dosage for clinically meaningful outcomes. Systematic review registration: International prospective register of systematic reviews (PROSPERO CRD42024508386).

The effect of resistance training on patients with knee osteoarthritis: a systematic review and meta-analysis

The objective of this study is to investigate the beneficial effects of resistance training (RT) on individuals suffering from knee osteoarthritis (KOA). In order to gather relevant studies from the beginning of various databases until January 2023, a comprehensive search was conducted on PubMed, Embase, Scopus, Web of Science, and The Cochrane Library. Additionally, manual searches were performed on the reference lists. The association between RT and KOA was analysed using a random-effects model. The results indicated that patients with KOA who underwent RT experienced a significant reduction in the WOMAC (Western Ontario and McMaster Universities Osteoarthritis) Pain index (WMD = -2.441; 95% CI = -3.610 to -1.273; p < 0.01), the WOMAC Stiffness index (WMD = -1.018; 95% CI = -1.744 to -0.293; p < 0.01), the WOMAC Function index (WMD = -7.208; 95% CI = -10.412 to -4.004; p < 0.01), and the VAS (Visual Analogue Scale) index (WMD = -5.721; 95% CI = -9.320 to -2.121; p < 0.01). These improvements were observed when compared to the control group. However, no significant difference was found in the 6-MWT (6-Minute Walk Test) index between the two groups (WMD = 2.659; 95% CI= -16.741 to 22.058; p = 0.788). Consequently, RT has the potential to positively enhance pain, stiffness, and function in patients with KOA, while the 6-MWT index may not exhibit significant improvement.

Exercise for osteoarthritis of the knee

BACKGROUND

Knee osteoarthritis (OA) is a major public health issue causing chronic pain, impaired physical function, and reduced quality of life. As there is no cure, self-management of symptoms via exercise is recommended by all current international clinical guidelines. This review updates one published in 2015.

OBJECTIVES

We aimed to assess the effects of land-based exercise for people with knee osteoarthritis (OA) by comparing: 1) exercise versus attention control or placebo; 2) exercise versus no treatment, usual care, or limited education; 3) exercise added to another co-intervention versus the co-intervention alone.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trial registries (ClinicalTrials.gov and World Health Organisation International Clinical Trials Registry Platform), together with reference lists, from the date of the last search (1st May 2013) until 4 January 2024, unrestricted by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated exercise for knee OA versus a comparator listed above. Our outcomes of interest were pain severity, physical function, quality of life, participant-reported treatment success, adverse events, and study withdrawals.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane for systematic reviews of interventions.

MAIN RESULTS

We included 139 trials (12,468 participants): 30 (3065 participants) compared exercise to attention control or placebo; 60 (4834 participants) compared exercise with usual care, no intervention or limited education; and 49 (4569 participants) evaluated exercise added to another intervention (e.g. weight loss diet, physical therapy, detailed education) versus that intervention alone. Interventions varied substantially in duration, ranging from 2 to 104 weeks. Most of the trials were at unclear or high risk of bias, in particular, performance bias (94% of trials), detection bias (94%), selective reporting bias (68%), selection bias (57%), and attrition bias (48%). Exercise versus attention control/placebo Compared with attention control/placebo, low-certainty evidence indicates exercise may result in a slight improvement in pain immediately post-intervention (mean 8.70 points better (on a scale of 0 to 100), 95% confidence interval (CI) 5.70 to 11.70; 28 studies, 2873 participants). Moderate-certainty evidence indicates exercise likely results in an improvement in physical function (mean 11.27 points better (on a scale of 0 to 100), 95% CI 7.64 to 15.09; 24 studies, 2536 participants), but little to no improvement in quality of life (mean 6.06 points better (on a scale of 0 to 100), 95% CI -0.13 to 12.26; 6 studies, 454 participants). There was moderate-certainty evidence that exercise likely increases participant-reported treatment success (risk ratio (RR) 1.46, 95% CI 1.11 to 1.92; 2 studies 364 participants), and likely does not increase study withdrawals (RR 1.08, 95% CI 0.92 to 1.26; 29 studies, 2907 participants). There was low-certainty evidence that exercise may not increase adverse events (RR 2.02, 95% CI 0.62 to 6.58; 11 studies, 1684 participants). Exercise versus no treatment/usual care/limited education Compared with no treatment/usual care/limited education, low-certainty evidence indicates exercise may result in an improvement in pain immediately post-intervention (mean 13.14 points better (on a scale of 0 to 100), 95% CI 10.36 to 15.91; 56 studies, 4184 participants). Moderate-certainty evidence indicates exercise likely results in an improvement in physical function (mean 12.53 points better (on a scale of 0 to 100), 95% CI 9.74 to 15.31; 54 studies, 4352 participants) and a slight improvement in quality of life (mean 5.37 points better (on a scale of to 100), 95% CI 3.19 to 7.54; 28 studies, 2328 participants). There was low-certainty evidence that exercise may result in no difference in participant-reported treatment success (RR 1.33, 95% CI 0.71 to 2.49; 3 studies, 405 participants). There was moderate-certainty evidence that exercise likely results in no difference in study withdrawals (RR 1.03, 95% CI 0.88 to 1.20; 53 studies, 4408 participants). There was low-certainty evidence that exercise may increase adverse events (RR 3.17, 95% CI 1.17 to 8.57; 18 studies, 1557 participants). Exercise added to another co-intervention versus the co-intervention alone Moderate-certainty evidence indicates that exercise when added to a co-intervention likely results in improvements in pain immediately post-intervention compared to the co-intervention alone (mean 10.43 points better (on a scale of 0 to 100), 95% CI 8.06 to 12.79; 47 studies, 4441 participants). It also likely results in a slight improvement in physical function (mean 9.66 points better, 95% CI 7.48 to 11.97 (on a 0 to 100 scale); 44 studies, 4381 participants) and quality of life (mean 4.22 points better (on a 0 to 100 scale), 95% CI 1.36 to 7.07; 12 studies, 1660 participants) immediately post-intervention. There was moderate-certainty evidence that exercise likely increases participant-reported treatment success (RR 1.63, 95% CI 1.18 to 2.24; 6 studies, 1139 participants), slightly reduces study withdrawals (RR 0.82, 95% CI 0.70 to 0.97; 41 studies, 3502 participants), and slightly increases adverse events (RR 1.72, 95% CI 1.07 to 2.76; 19 studies, 2187 participants). Subgroup analysis and meta-regression We did not find any differences in effects between different types of exercise, and we found no relationship between changes in pain or physical function and the total number of exercise sessions prescribed or the ratio (between exercise group and comparator) of real-time consultations with a healthcare provider. Clinical significance of the findings To determine whether the results found would make a clinically meaningful difference to someone with knee OA, we compared our results to established 'minimal important difference' (MID) scores for pain (12 points on a 0 to 100 scale), physical function (13 points), and quality of life (15 points). We found that the confidence intervals of mean differences either did not reach these thresholds or included both a clinically important and clinically unimportant improvement.

AUTHORS' CONCLUSIONS

We found low- to moderate-certainty evidence that exercise probably results in an improvement in pain, physical function, and quality of life in the short-term. However, based on the thresholds for minimal important differences that we used, these benefits were of uncertain clinical importance. Participants in most trials were not blinded and were therefore aware of their treatment, and this may have contributed to reported improvements.

Efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for knee osteoarthritis: a systematic review and network meta-analysis

Purpose

While strengthening exercises are recommended for knee osteoarthritis (KOA) treatment, the optimal type of muscle contraction remains unclear, with current research showing conflicting results. This network meta-analysis (NMA) aims to evaluate the efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for KOA patients and provide clinical references.

Methods

We conducted the NMA following the PRISMA-NMA. A comprehensive search of five databases (PubMed, Web of Science, CENTRAL, Embase, and SPORTDiscus) up to August 2024 identified randomized controlled trials (RCTs) investigating lower limb strengthening exercises in KOA patients. Control groups included receiving usual care, only providing health education, or no intervention at all. Outcomes analyzed included pain, physical function, quality of life, and muscle strength.

Results

Forty-one studies (2,251 participants) were included. Twenty-eight studies used rigorous randomization; eighteen reported allocation concealment. All had high performance bias risk due to exercise interventions. Regarding efficacy, isokinetic exercise ranked highest in pain relief (SMD = 0.70, 95% CI: 0.50-0.91, SUCRA = 82.6%), function improvement (SMD = 0.75, 95% CI: 0.57-0.92, SUCRA = 96.1%), and enhancement in muscle strength (SMD = 0.56, 95% CI: 0.34-0.78, SUCRA = 90.1%). Isometric exercise ranked highest in improving quality of life (SMD = 0.80, 95% CI: 0.28-1.31, SUCRA = 90.5%). Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions (≥5 times/week) showed superior pain relief compared with low-frequency (≤3 times/week) for isotonic, isometric, and isokinetic exercise.

Conclusion

This NMA suggests isokinetic exercise may be most effective for pain, function, and muscle strength in KOA patients, while isometric exercise benefits quality of life most. Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions appear more effective than low-frequency ones. These findings support personalized KOA treatment, considering efficacy, accessibility, and patient-specific factors. Study biases, heterogeneity, and other limitations may affect result reliability. Future research should focus on high-quality studies with standardized protocols and analyze dose-response relationships to refine KOA treatment strategies.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024582525, identifier: CRD42024582525.

Mesenchymal stem cells derived from human adipose tissue exhibit significantly higher chondrogenic differentiation potential compared to those from rats

BACKGROUND

Osteoarthritis is a prevalent joint disease affecting both humans and animals. It is characterized by articular cartilage degeneration and joint surface eburnation. Currently, no effective pharmacological treatment is available to restore the original function and structure of defective cartilage.

OBJECTIVE

This study explores the potential of stem cell-based therapy in treating joint diseases involving cartilage degeneration, offering a promising avenue for future research and treatment. The primary aim was to compare the characteristics and, more importantly, the chondrogenic differentiation potential of human and rat adipose-derived mesenchymal stem cells (AD-MSCs).

METHODS

Rat adipose tissue was collected from Sprague Dawley rats, while human adipose tissue was obtained in the form of lipoaspirate. The mesenchymal stem cells (MSCs) were then harvested using collagenase enzyme and subcultured. We meticulously evaluated and compared the cell morphology, percentage of cell viability, population doubling time, metabolic proliferation, and chondrogenic differentiation potential of MSCs harvested from both sources. Chondrogenic differentiation was induced at passage 3 using the 3D pellet culture method and assessed through histological and molecular analysis.

RESULTS

The findings revealed that human and rat AD-MSCs were phenotypically identical, and an insignificant difference was found in cell morphology, percentage of cell viability, metabolic proliferation, and population doubling time. However, the chondrogenic differentiation potential of human AD-MSCs was evaluated as significantly higher than that of rat AD-MSCs.

CONCLUSION

The current study suggests that research regarding chondrogenic differentiation of rat AD-MSCs can be effectively translated to humans. This discovery is a significant contribution to the field of regenerative medicine and has the potential to advance our understanding of stem cell-based therapy for joint diseases.

Effect of strength training on knee proprioception in patients with knee osteoarthritis: A systematic review and meta-analysis

Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g ​= ​-1.33 [-2.33, -0.32], g = ​-2.29 [-2.82, -1.75] and g ​= ​-2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g ​= ​-0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

Effectiveness of Yijinjing exercise in the treatment of early-stage knee osteoarthritis: a randomized controlled trial protocol

INTRODUCTION

Knee osteoarthritis (KOA) is still a challenging degenerative joint disease with high morbidity and disease burden. Early-stage KOA, the focus of this study, could present a Window of Opportunity to arrest the disease process and reduce the disease burden. Yijinjing exercise is an important part of physical and psychological therapies in Traditional Chinese Exercise and may be an effective treatment. However, there is no clinical efficacy assessment of Yijinjing exercise for patients with early-stage KOA. Therefore, we designed a randomised controlled trial to evaluate the effectiveness of Yijinjing exercise on patients with early-stage KOA.

METHODS AND ANALYSIS

This is a parallel-design, two-arm, analyst assessor-blinded, randomised controlled trial. In total, 60 patients with early-stage KOA will be recruited and randomly assigned to the Yijinjing exercise group (n=30) and health education group (n=30) at a ratio of 1:1, receiving 12 weeks of Yijinjing exercise or health education accordingly. The primary outcome will be measured with the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes will include the Visual Analogue Scale, Short-Form 36 Item Health Survey Questionnaire, Beck Depression Inventory, Perceived Stress Scale, Berg Balance Scale, and Gait Analysis for a comprehensive assessment. Outcome measures are collected at baseline, at 12 week ending intervention and at the 12 week, 24 week and 48 week ending follow-up. The primay time point will be 12 weeks postintervention. Adverse events will be recorded for safety assessment.

ETHICS AND DISSEMINATION

This study has been approved by the ethical application of the Shanghai Municipal Hospital of Traditional Chinese Medicine Ethics Committee (2021SHL-KY-78).

TRIAL REGISTRATION NUMBER

ChiCTR2200065178.

Quadriceps Strength, Postural Stability, and Pain Mediation in Bilateral Knee Osteoarthritis: A Comparative Analysis with Healthy Controls

Bilateral knee osteoarthritis (OA) poses significant challenges to individuals' functional abilities, including quadriceps strength, postural stability, and pain perception. Understanding the complex relationships among these factors is crucial for enhancing knee OA management strategies. The primary objective of this research is to evaluate and draw comparisons between the strength of the quadriceps and the level of postural stability in two distinct groups: individuals afflicted with bilateral knee OA and those who are healthy. Furthermore, the study seeks to examine the potential correlation between the strength of the quadriceps and the level of postural stability in individuals with knee OA. In addition to this, an investigation into the potential mediating effect of pain on the relationship between these physiological factors will also be conducted. A total of 95 participants with bilateral knee OA and 95 healthy controls were recruited. Quadriceps strength was assessed using dynamometry and postural stability was evaluated through anterior-posterior and medial-lateral sway measurements along with the ellipse area using a force plate. Pain levels were measured using the Visual Analog Scale (VAS). Mediation analysis was employed to explore the role of pain in mediating the relationship between quadriceps strength and postural stability. Statistical analyses included t-tests, Pearson correlation coefficients, and mediation analysis. Knee OA participants exhibited significantly lower quadriceps strength (1.08 Nm/kg ± 0.54) compared to controls (1.54 Nm/kg ± 0.57, p < 0.001). They also demonstrated compromised postural stability with increased anterior-posterior sway (9.86 mm ± 3.017 vs. 2.98 mm ± 1.12, p < 0.001), medial-lateral sway (7.87 mm ± 2.23 vs. 3.12 mm ± 1.34, p < 0.001), and larger ellipse area (935.75 mm2 ± 172.56 vs. 436.19 mm2 ± 135.48, p < 0.001). Negative correlations were observed between quadriceps strength and postural stability variables (r = from -0.43 to -0.51, p < 0.001). Pain significantly mediated the relationship between quadriceps strength and postural stability variables (p < 0.05). This study highlights the associations between quadriceps strength, postural stability, and pain mediation in individuals with bilateral knee OA. Our findings emphasize the need for targeted interventions addressing quadriceps weakness and compromised postural stability. Additionally, the mediation effect of pain underscores the complexity of these relationships, offering insights for more effective management strategies.

Low-frequency whole-body vibration can enhance cartilage degradation with slight changes in subchondral bone in mice with knee osteoarthritis and does not have any morphologic effect on normal joints

PURPOSES

To evaluate the effects of low frequency whole-body vibration (WBV) on degeneration of articular cartilage and subchondral bone in mice with destabilization of the medial meniscus (DMM)induced osteoarthritis(OA) and mice with normal knee.

METHODS

Ten-week-old C57BL/6J male mice received DMM on right knees, while the left knees performed sham operation. There were six groups: DMM, SHAM DMM, DMM+WBV,SHAM DMM+WBV, DMM+ NON-WBV and SHAM DMM+NON-WBV. After four weeks, the knees were harvested from the DMM and SHAM DMM group. The remaining groups were treated with WBV (10 Hz) or NON-WBV. Four weeks later, the knees were harvested. Genes, containing Aggrecan(Acan) and CollagenⅡ(Col2a1), Matrix Metalloproteinases 3 and 13(MMP3,13), TNFα and IL6, were measured and staining was also performed. OA was graded with OARSI scores, and tibial plateaubone volume to tissue volume ratio(BV/TV), bone surface area to bone volume ratio (BS/BV), trabecular number(Tb.N) and trabecular thickness separation(TS) between groups were analyzed.

RESULTS

Increased OARSI scores and cartilage degradation were observed after WBV. BV/TV, Tb.N and TS were not significant between the groups. Significant reductions were observed in MMP3, MMP13, Col2a1, Acan, TNFα and IL6 in the DMM+WBV compared to SHAM DMM+WBV group. BV/TV, BS/BV, Tb.N, TS and OARSI scores were not significantly changed in the left knees. IL6 expression in the SHAM DMM+WBV group was significantly increased compared with the SHAM DMM+ NON-WBV group, while Col2a1, Acan and MMP13 expression decreased.

CONCLUSION

WBV accelerated cartilage degeneration and caused slight changes in subchondral bone in a DMM-induced OA model. WBV had no morphologic effect on normal joints.

Melatonin ameliorates osteoarthritis rat cartilage injury by inhibiting matrix metalloproteinases and JAK2/STAT3 signaling pathway

OBJECTIVE

To observe the effect of melatonin intervention on rat knee osteoarthritis (KOA) model and explore its mechanism.

METHODS

A total of 81 Sprague-Dawley (SD) rats were employed. Haematoxylin and eosin (H&E) staining and safranin o-solid green staining were used to observe the changes of pathology in KOA, and inflammation factors in serum were detected by enzyme-linked immunosorbent assay (ELISA), type II collagen (Col-II) was detected by immunohistochemistry, chondrocyte apoptosis was detected by TdT-mediated dUTP nick-end labeling (TUNEL). The expression of matrix metalloproteinases (MMPs) and JAK2/STAT3 signaling were detected by western blot.

RESULTS

Melatonin treatment ameliorated the histomorphology of knee joint in rats compared to the model group. The contents of TNF-α, IL-6, and IL-1β in serum were decreased after melatonin treatment. In addition, compared to the model group, the positive expression of Col-II increased, the chondrocyte apoptosis decreased after melatonin treatment. Interestingly, the expression levels of MMP3, MMP9, MMP13, p-JAK2 and p-STAT3 decreased (p < 0.05). Importantly, melatonin combined with AG490 is significantly ameliorates histomorphology of knee joint, reduced cartilage loss compared with melatonin treatment alone.

CONCLUSIONS

Melatonin treatment can effectively diminish the cartilage injury. Its mechanism may be related to protect the articular cartilage by reducing the release of inflammatory factors, inhibit the expression of MMPs and JAK2/STAT3 signaling.

EFFECTS OF VIBRATION TRAINING ON UPPER LIMBS OF VOLLEYBALL PLAYERS

ABSTRACT Introduction: The research on vibration training has experienced a period of development in many projects, such as badminton, handball, long jump, and volleyball. However, there is still no quantitative research evaluation of its effects on the development of shoulder, elbow, and upper limb muscle strength in volleyball athletes. It is believed that a specific training protocol with vibration may bring benefits to sensory-motor performance and muscle strength implementation in volleyball athletes. Objective: To study the effects of vibration training on upper limb function in volleyball players. Methods: Literature, experimental, and mathematical-statistical research methods were used to explore the relationship between vibration training under the muscle strength of the upper limbs and their joints. Results: The vibration training with an amplitude of 2mm, at a vibration frequency between 30Hz and 45Hz, the frequency of vibration training presented inversely proportional to the effect of vibration training. Conclusion: Vibration training showed the benefits of motor coordination and increased muscle strength in volleyball players. An appropriate vibration training strategy can maximize athletes’ skills, such as body coordination, flexibility, and jumping ability. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

CORE STRENGTH TRAINING INFLUENCES BASKETBALL PLAYERS’ BODY

ABSTRACT Introduction Modern basketball is very competitive and enjoyable; it combines several factors. Basketball requires specific physical characteristics such as high stature, which raises the position of the center of gravity, making the stability angle smaller. This compromises stability, especially in sudden speed and direction changes, because it requires a large base opening. The core musculature is intimately involved with body balance; however, there is a lack of studies verifying the impact of specific training of this region on balance in basketball athletes. Objective To explore the influence of core strengthening on the physical fitness of college basketball players. Methods 12 college basketball players were selected and randomly divided into a control group and an experimental group. The experimental group performed core strengthening training, while the control group practiced traditional strength training. After six weeks, physical fitness and basic skills were compared between the groups. Data were statistically treated and discussed confronting the literature. Results Basketball players in the experimental group obtained higher fast dribbling passes and shots than before the experiment (P<0.05), there was no statistically significant difference in several indicators in the control group ( P>0.05); Basketball players in the experimental group had higher fast dribbling passes and shots than the control group (P<0.05), there was no statistically significant difference in approach height between the experimental group and the control group (P>0.05). Conclusion Core strengthening training can improve the physical fitness of college basketball players. Evidence level II; Therapeutic Studies - Investigating the results.

Does land-based exercise-therapy improve physical activity in people with knee osteoarthritis? A systematic review with meta-analyses

PRIMARY OBJECTIVE

Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA).

DESIGN

Systematic review and meta-analysis of randomised or quasi-randomised trials investigating land-based exercise-therapy on physical activity, fitness, and general health in people with KOA. We updated a 2013 Cochrane review search on exercise-therapy for KOA in April 2021 and applied the Cochrane Risk-of-Bias Tool 1.0 to included articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. GRADE was used to assess certainty of the evidence.

RESULTS

Twenty-eight randomised controlled trials (2,789 participants) evaluating the effects of resistance-training (n = 10), walking (n = 6) and mixed-exercise programs (n = 7) were identified. Low to moderate certainty evidence indicated small increases in physical activity for exercise-therapy compared to non-exercise interventions in the short-term (SMD, 95% CI = 0.29, 0.09 to 0.50), but not the medium- (0.03, -0.11 to 0.18) or long-term (-0.06, -0.34 to 0.22). Low certainty evidence indicated large increases in physical activity for walking programs (0.53, 0.11 to 0.95) and mixed-exercise programs (0.67, 0.37 to 0.97) compared to non-exercise interventions in the short-term. Low certainty evidence indicated moderate and small increases in physical activity for resistance-training combined with education focused on pain coping skills and self-efficacy compared to education alone at medium-term follow-up (0.45, 0.19 to 0.71).

CONCLUSION

Walking and mixed-exercise, but not resistance-training, may improve physical activity in people with KOA in the short-term. Combining resistance-training with education may increase physical activity in the medium-, but not the long-term, highlighting the potential importance of developing more effective longer-term interventions for people with KOA. Future studies evaluating land-based exercise-therapy are encouraged to include physical activity outcomes and longer-term follow-up to increase the certainty of evidence.

The Application of Whole-Body Vibration Training in Knee Osteoarthritis

With the gradual increase of the aging population in Chinese society, the incidence of knee osteoarthritis showed an increasing trend. However, there are very few practical solutions for it. As a novel neuromuscular training technique, whole-body vibration training has become a candidate for treating knee osteoarthritis. In this review, we firstly elaborated on the mode of action and influence factors of the whole-body vibration training. Next, we summarized its effects in knee osteoarthritis, including improving knee function and some uncertain muscle function and proprioception effects. Next, we also summarized its possible mechanisms, including improving bone microstructure, delaying articular cartilage degeneration, modulating inflammatory cells and inflammatory factors. Then, we summarized the clinical effectiveness of whole-body vibration training by analyzing some clinical randomized controlled trials. Finally, based on the above summary, we analyzed and listed the limitations of whole-body vibration training in treating knee osteoarthritis and found the shortcomings in the existing studies. This review provides ideas for the future application of whole-body vibration training in the treatment of knee osteoarthritis.