Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial

Concurrent effects of high-intensity interval training and vitamin D supplementation on bone metabolism among women diagnosed with osteoporosis: a randomized controlled trial

BACKGROUND

Osteoporosis is often responsible for bone fragility and increased fracture risk due to the micro-architectural deterioration of bone tissue. In addition to nutritional supplements, exercise is considered an adjunct factor in safeguarding bone health. This study aimed to investigate the effects of 16-week high-intensity interval training (HIIT) and vitamin D supplementation on bone mineral density (BMD) in women with osteoporosis.

TRIAL DESIGN

This study used a four-arm pretest-posttest experimental randomized controlled design.

METHODS

One hundred twenty sedentary women aged (30-50 years), diagnosed with osteoporosis were recruited in this study. Patients were randomly classified into four groups with 30 patients in each group: control group (normal daily activities), exercise group (HIIT-exercise for 16 weeks), Vitamin D group (vitamin D 800IU/ day for 16 weeks), and concurrent group (HIIT exercise plus vitamin D for 16 weeks). Anthropometric measurements, BMD, and serum levels of vitamin 25-(OH) D, Osteocalcin, s-BAP, and calcium were estimated in all participants before and after exercise training.

RESULTS

Serum samples revealed that bone resorption markers, osteocalcin, total calcium, s-BAP, and vitamin 25(OH) D significantly improved in all groups; there was greater improvement in the HIIT training-vitamin D group than in the HIIT training, vitamin D, and control groups. Furthermore, the HIIT training-vitamin D group showed improvements in hip (right and left) and lumbar spine BMD than the HIIT training, Vitamin D, and Control groups. BMD improvements correlated positively with serum osteocalcin levels and total calcium and negatively with BMI and s-BAP.

CONCLUSIONS

Sixteen weeks of HIIT and vitamin D consumption showed greater benefits for BMD levels in women with osteoporosis than either vitamin D consumption or HIIT training alone. Therefore, HIIT plus vitamin D consumption may be a strategic option to prevent BMD reduction with aging or to slow demineralization.

TRIAL REGISTRATION

The study protocol was retrospectively registered at 'ClinicalTrials.gov PRS' under the trial identifier NCT06624657, dated 1/10/2024.

Reliability of range of motion in straight leg raise and hip extension tests among healthy young adults using a smartphone application

INTRODUCTION

Measuring range of motion (ROM) is an important skill for clinicians because it can help in the accurate interpretation of a patient's condition. Recently, ROM tests using smartphone applications have been performed in clinical settings, with the tests demonstrating high reliability and validity. This study aimed to identify the usefulness of ROM tests conducted using smartphone applications by examining the reliability of straight leg raise (SLR) and hip extension (HE) tests.

METHODS

This cross-sectional observational study included 72 lower limbs of 36 participants (19 men and 17 women; mean age, 21.6 ± 0.8 years). Passive SLR-ROM and HE-ROM were measured in 1° increments using an iPhone goniometer (IG). Intra-rater and inter-rater reliabilities were calculated using intraclass correlation coefficients (ICCs). ROM test systematic error was confirmed using Bland-Altman analysis, and ROM measurement error was calculated.

RESULTS

The ICCs of the IG ROM tests were 0.820 or higher. According to Bland-Altman analyses, SLR-ROM and HE-ROM did not acknowledge fixed and proportional biases. Thus, ROM measurement error was calculated as the minimal detectable change (MDC). The intra-rater and inter-rater MDC 95% confidence interval (MDC95) values of SLR-ROM were 3.3° and 10.2°, respectively. The intra-rater and inter-rater MDC95 values for HE-ROM were 3.9° and 9.6°, respectively.

CONCLUSION

IG ROM tests were highly reliable, simple, and easy to perform. SLR-ROM and HE-ROM tests conducted using smartphone applications may be useful indices for clinical decision-making.

Non-operative Treatment Options for Osteoarthritis in the Hip

With the increased disability associated with osteoarthritis (OA) progression, and the significant socioeconomic burden of joint replacement surgeries, there is a need for more reliable conservative treatments for patients presenting with hip OA. Most studies of OA treatments involve the knee. We conducted a literature search and reviewed non-operative hip OA treatment recommendations by the Osteoarthritis Research Society International, the American College of Rheumatology, American Academy of Orthopedic Surgeons, and European Alliance of Associations for Rheumatology, as well as Cochrane Reviews. Non-steroidal anti-inflammatory drugs and corticosteroid injections are the most supported and recommended options for hip OA; other medications with potential benefits for short-term pain relief include acetaminophen and tramadol. Most societies recommend against the use of glucosamine, typical opioids, and viscosupplementation injections. Platelet-rich plasma has potential benefits, but evidence of its effectiveness is incomplete. Further research is needed to better inform and guide clinicians who create treatment plans for patients with symptomatic hip OA.

Highlighting the Benefits of Rehabilitation Treatments in Hip Osteoarthritis

Background and objectives: Due to its frequency and possible complications, hip arthrosis or hip osteoarthritis (hip OA) has a high social impact, its advanced stages eventually leading to irreversible lesions involving major complications or surgery. In the early stages, conservative treatment plays a key role in the prophylaxis of complications and in slowing down the degenerative process. The association between an appropriate drug therapy (DT) and a rehabilitation treatment (RT)—including individualized physical therapy (PT) and adapted occupational therapy (OT)—provides good results. Our objective was to highlight the benefits of associating RT with DT in patients with hip OA. Materials and Methods: An observational follow-up study was conducted between 2018−2021, which included 100 patients with hip OA divided into two groups: the study group—group A (50 subjects who complied with RT) and the control group—group B (who did not comply with RT). To evaluate them, the evolution of the Lequesne hip index (LHI), Tinetti test (TT) and the hip joint mobility: flexion (FH) and abduction (AH) were monitored before the beginning of the study (T0) and after one-year (T1) for each patient. The mean values of the parameters, the standard deviations, the frequency intervals, as well as the tests of statistical significance were calculated using the Student method (t-test) and χ2, ANOVA (Bonferroni) being used to compare the means. Results: Compared to the evolution of group B, improvements were observed in group A, as follows: in LHI group A (p = 0.023) vs. group B (p = 0.650); in TT group A (p = 0.011) vs. group B (p < 0.001); in FH group A (p = 0.001) vs. group B (p = 0.025); in AH group A (p = 0.001) vs. group B (p < 0.001). BMI changes were non-significant in both groups A (p = 0.223) and B (p = 0.513). Evaluating group A, the most significant improvements of the studied parameters were observed in the age group 41−50 years. Conclusions: The study reveals the benefits of combining RT with DT in patients with especially early-stage hip OA, aged up to 50 years old.

Automatic hip abductor muscle fat fraction estimation and association with early OA cartilage degeneration biomarkers

The aim of this study was to develop an automatic segmentation method for hip abductor muscles and find their fat fraction associations with early stage hip osteoarthritis (OA) cartilage degeneration biomarkers. This Institutional Review Board approved, Health Insurance Portability and Accountability Act compliant prospective study recruited 61 patients with evidence of hip OA or Femoroacetabular Impingement (FAI). Magnetic resonance (MR) images were acquired for cartilage segmentation, T_1ρ and T₂ relaxation times computation and grading of cartilage lesion scores. A 3D V-Net (Dice loss, Adam optimizer, learning rate = 1e^-4 , batch size = 3) was trained to segment the three muscles (gluteus medius, gluteus minimus, and tensor fascia latae). The V-Net performance was measured using Dice, distance maps between manual and automatic masks, and Bland-Altman plots of the fat fractions and volumes. Associations between muscle fat fraction and T_1ρ , T₂ relaxation times values were found using voxel based relaxometry (VBR). A p < 0.05 was considered significant. The V-Net had a Dice of 0.90, 0.88, and 0.91 (GMed, GMin, and TFL). The VBR results found associations of fat fraction of all three muscles in early stage OA and FAI patients with T_1ρ , T₂ relaxation times. Using an automatic, validated segmentation model, the associations derived between OA biomarkers and muscle fat fractions provide insight into early changes that occur in OA, and show that hip abductor muscle fat is associated with markers of cartilage degeneration.

Influence of hip and knee positions on gluteus maximus and hamstrings contributions to hip extension torque production

BACKGROUND

Diminished gluteus maximus muscle strength has been proposed to be contributory to various lower-limb injuries. As such, it is of clinical importance to perform hip extensor strength testing in a position that biases torque contribution of the gluteus maximus relative to the other hip extensors (i.e. hamstrings).

OBJECTIVES

To determine the relative torque contributions of the gluteus maximus and hamstring muscles in various hip extensor strength testing positions.

METHODS

13 Young, healthy participants performed maximum isometric hip extension on a dynamometer in 4 different positions that varied in terms of hip and knee flexion. Surface electromyography (EMG) was used to assess activation of gluteus maximus and hamstrings during the maximum isometric contractions. Normalized EMG data were used as an input to determine individual muscle contribution to hip extension torque production using SIMM modeling software. The gluteus maximus/hamstring torque contribution ratio was compared across the 4 positions using a one-way repeated-measures ANOVA.

RESULTS

The highest gluteus maximus torque contribution value occurred in positions where the hip was flexed to 45°, while the highest hamstring torque contribution occurred in positions in which the knee was fully extended. The gluteus maximus/hamstring torque contribution ratio was highest at 0° of hip extension and 90° of knee flexion.

CONCLUSION

Testing isometric hip extensor strength at 0° of hip extension and 90° of knee flexion should be considered in order to bias torque production of the gluteus maximus relative to the hamstrings.

Combined therapies with exercise, ozone and mesenchymal stem cells improve the expression of HIF1 and SOX9 in the cartilage tissue of rats with knee osteoarthritis

PURPOSE

Knee osteoarthritis (OA) is a common type of degenerative joint disease which decreases the quality of life. Sex-determining region Y box 9 (SOX9) and hypoxia-inducible factor-1 (HIF1) are considered as the key regulators of OA. We investigated the effect of combined therapies with mesenchymal stem cells (MSCs), ozone (O3) and exercise training on SOX9 and HIF1 expression in the cartilage of rats with knee OA.

METHODS

Knee OA was induced by surgical method. OA rats were divided into model, MSCs, ozone, exercise, MSCs + ozone, MSCs + exercise, ozone + exercise and MSCs + ozone + exercise groups. Rats in the MSCs group received intraarticular injection of 1 × 106 cells/kg. Rats in the ozone group received O3 at the concentration of 20 μg/mL, once weekly for 3 weeks. Rats in the exercise group were trained on rodent treadmill three times per week. 48 hours after the programs, cartilage tissues were isolated and the expression of SOX9 and HIF1 was determined using Real-Time PCR.

RESULTS

Significant differences were found in the expression of SOX9 and HIF1 between groups (P < 0.0001). Although combined therapies with exercise, MSCs and O3 significantly increased the expression of SOX9 and HIF1 in the cartilage tissue of rats with knee OA, combination of exercise with O3 was significantly more effective compared to the other combined therapies (P < 0.001).

CONCLUSIONS

Combined therapy with exercise, MSCs and O3 significantly increased the expression of SOX9 and HIF1 genes in the cartilage of rats with knee OA; however, exercise + O3 was significantly more effective.

The effects of gluteal squeezes compared to bilateral bridges on gluteal strength, power, endurance, and girth

BACKGROUND

Hip extension weakness is correlated with low back, hip, and knee pathology. Isometric gluteal squeezes have been shown to elicit high electromyographic gluteal activity. However, there is little research regarding the specific effects of isometric gluteal squeezes on hip strength and functional outcomes. The purpose of this study was to identify the effects of gluteal squeezes on hip extension strength, vertical jump, broad jump, single-leg bridge endurance, and gluteal girth compared to bilateral gluteal bridging.

METHODS

A total of 32 healthy university students (mean age 23.28 ± 2.15 years) were randomly assigned to perform either gluteal squeezes or bilateral bridges daily. Subjects were tested at baseline and after 8 weeks of training. Subjects' hip extension strength, vertical jump, broad jump, single-leg bridge endurance, and gluteal girth were tested.

RESULTS

No statistically significant differences were found between the bridge and squeeze groups after 8 weeks of training. Both groups significantly improved hip extension strength bilaterally (p = 0.000-0.011). The squeeze group significantly increased gluteal girth at the level of the greater trochanter (p = 0.007), but no significant girth increase was seen in the bridge group (p = 0.742). Although increases were seen in both groups for the endurance and jump tasks, no statistically significant changes occurred for those outcomes. All outcome measurements demonstrated high reliability (ICC = 0.93-0.99).

CONCLUSION

Gluteal squeezes were as effective as bilateral bridges for increasing hip extension strength. Gluteal squeezes also significantly increased girth at the level of the greater trochanter. These results provide clinical and aesthetic reasons to perform gluteal squeezes.

Aquatic Exercise Program for Individuals With Osteoarthritis: Pain, Stiffness, Physical Function, Self-Efficacy

PURPOSE

This research was conducted to determine the effects of an aquatic exercise program on pain, stiffness, physical function, and self-efficacy in individuals with osteoarthritis.

DESIGN

A randomized controlled trial.

METHODS

Participants in the experimental group participated in the aquatic exercise program three times a week for 8 weeks; participants in the control group did not.

FINDINGS

The mean scores of the experimental group on the pain, stiffness, and difficulty in carrying out physical functions subscales of the Western Ontario and McMaster Universities Osteoarthritis Index decreased significantly, whereas those of the control group decreased very little. The mean scores of the experimental group on the Arthritis Self-Efficacy Scale and the isokinetic muscle strength measurements increased, but those of the control group did not change in the final measurements. The difference between the groups was statistically significant.

CONCLUSIONS

Through the study, it was determined that the aquatic exercise program decreased pain, stiffness, and difficulty in carrying out physical functions and increased self-efficacy and muscle strength of individuals with osteoarthritis.

CLINICAL RELEVANCE

The aquatic exercise program can be used by nurses as a reference in the management of osteoarthritic patients' health status.