Photobiomodulation via a cluster device associated with a physical exercise program in the level of pain and muscle strength in middle-aged and older women with knee osteoarthritis: a randomized placebo-controlled trial

Osteoarthritis (OA) is a chronic joint disease that leads to pain and functional incapacity. The aim of the study is to investigate the effects of the incorporation of photobiomodulation (PBM) (via cluster) into a physical exercise program on the level of pain, lower limb muscle strength, and physical capacity, in patients with knee OA. Sixty-two female volunteers with a diagnosis of knee OA were distributed in 4 groups: exercise associated with placebo PBM group, exercise associated with active PBM group, active PBM group, and placebo PBM group. Sixteen sessions of lower limb strength exercises and PBM via cluster (808 nm, 100 mW, 7 points each side, 56 J total) were performed. The level of pain, physical capacity, and lower limb muscle strength were evaluated with the use of the numeric pain rating scale (NPRS), 6-min walking test (6-MWT) and timed up and go (TUG), and maximal voluntary isometric torque (MVIT) before and after the interventions. Both groups presented a significant decrease in the level of pain when compared with the placebo-treated women. Furthermore, the 6-MWT showed that the trained groups (with or without PBM) demonstrated higher values in the distance walked comparing pre and post-treatment values. The same behavior was found for the MVIT load before and after intervention. TUG was higher for all the treated with exercise groups comparing the pre and post-treatment values. Physical exercise and PBM showed analgesic effects. However, PBM did not have any extra effect along with the effects of exercise in improving the distance walked, the TUG, and the muscle strength.

Trial registration: RBR-7t6nzr

     

Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial

ObjectiveThe objective of this study was to verify the effects of resisted and proprioceptive exercises program for the treatment of patients diagnosed with patellofemoral pain syndrome (PFPS).Design methodRandomized Controlled Trial – level of evidence, II.MethodsSixty female patients, clinically diagnosed with PFPS, were allocated into two experimental groups. The exercise group (ExG) underwent 6 weeks of a resisted and proprioceptive exercises for the trunk muscles, abductors and lateral hip rotators and knee extensors. The Guidance Group (GG) received educational, cognitive and behavioral guidance on healthcare. Before and after the program implementation period, all participants were evaluated in relation to the injured limb for pain assessment, subjective functionality, maximum isometric strength and 2D biomechanical analysis.ResultsAfter a six-week follow-up, ExG showed significant improvement in the Numerical Pain Rating Scale, Anterior Knee Pain Scale and Knee Outcome Survey- Activities of Daily Living Scale when compared to the control group (p ≤ 0,05). The ExG also proved superior for increased muscle strength of knee extensors, hip abductors, decreased dynamic knee valgus and pelvic drop in relation to GG (p ≤ 0.05). However, when we consider the strength of the hip lateral rotator muscles there was no difference between the two interventions (p > 0.05).ConclusionResisted and proprioceptive exercises yielded superior results to those of a treatment focused on educational, cognitive and behavioral guidance in improving pain and lower limb function for women with PFPS.     

Exercise and Hand Osteoarthritis Symptomatology: A Controlled Crossover Trial

Study DesignRandomized Clinical Trial.IntroductionHand exercises have been recommended as treatment for hand osteoarthritis (OA) but research evidence is sparse.Purpose of the StudyTo investigate effects of daily 16-week home-based hand exercise among persons with hand OA.MethodsForty-six older adults completed a crossover trial with washout between exercise and sham treatments. The AUSCAN physical function sub-scale served as the primary outcome measure. Other outcomes included pain and stiffness sub-scales, dexterity, and grip & pinch strengths.ResultsChanges in AUSCAN sub-scales did not differ between exercise and sham treatments. No changes in dexterity were seen. Grip and pinch measures modestly improved after exercise but not sham.ConclusionsIt is possible that our exercise protocol may have been too ambitious for this age group. Future research will further the understanding of the role of hand exercise in hand OA symptomatology.Level of Evidence2b.     

Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises

STUDY DESIGN: Prospective, single-group, repeated-measures design. OBJECTIVE: To identify exercises that could be used for strength development and the exercises that would be more appropriate for endurance or stabilization training. BACKGROUND: The exercises analyzed are often used in rehabilitation programs for the spine, hip, and knee. They are active exercises using body weight for resistance; thus a clinician is unable to determine the amount of resistance being applied to a muscle group. Electromyographic (EMG) analysis can provide a measure of muscle activation so that the clinician can have a better idea about the effect the exercise may have on the muscle for strength, endurance, or stabilization. METHODS AND MEASURES: Surface EMG analysis was carried out in 19 males and 11 females while performing the following 9 exercises: active hip abduction, bridge, unilateral-bridge, side-bridge, prone-bridge on the elbows and toes, quadruped arm/lower extremity lift, lateral step-up, standing lunge, and using the Dynamic Edge. The rectus abdominis, external oblique abdominis, longissimus thoracis, lumbar multifidus, gluteus maximus, gluteus medius, vastus medialis obliquus, and hamstring muscles were studied. RESULTS: In healthy subjects, the lateral step-up and the lunge exercises produced EMG levels greater than 45% maximum voluntary isometric contraction (MVIC) in the vastus medialis obliquus, which suggests that they may be beneficial for strengthening that muscle. The side-bridge exercise could be used for strengthening the gluteus medius and the external oblique abdominis muscles, and the quadruped arm/lower extremity lift exercise may help strengthen the gluteus maximus muscle. All the other exercises produced EMG levels less than 45% MVIC, so they may be more beneficial for training endurance or stabilization in healthy subjects. CONCLUSION: Our results suggest these exercises could be used for a core rehabilitation or performance enhancement program. Depending on the individual needs of a patient or athlete, some of the exercises may be more beneficial than others for achieving strength.     

Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS)

The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. METHODS: Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. CONCLUSIONS AND RECOMMENDATIONS: For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).     

Early prevention of complex decongestive therapy and rehabilitation exercise for prevention of lower extremity lymphedema after operation of gynecologic cancer

ObjectiveTo investigate efficacy of early prevention of complex decongestive therapy and rehabilitation exercise for prevention of postoperative lower limb extremity lymphedema for patients with gynecologic cancer.Methods109 female patients were randomly divided into two groups, the control group who only received routine treatment and the CDT group who received both CDT and rehabilitation exercise. For rehabilitation exercise, patients received additional rehabilitation exercise strategy including professional education and full range exercise of hip joint. The incidence of lower extremity lymphedema was recorded. A simple scale for patients’ lower extremity lymphedema was designed. The diameter of low limbs (both thighs and calves) was also measured The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Brief Fatigue Inventory (BFI) was used for measurement of quality of life.ResultsThe incidence of lower extremity lymphedema was 15.09% cases of CDT group and 32.14% in the control group. K-M curve showed the lymphedema free time in CDT group was significantly longer. The subjective scores for heaviness of lower limbs, pain, numbness and dysfunction, as well as the diameters of both thighs and calves were lower in the CDT group. In both groups, the values of EORTC QLQ-C30-GHS and EORTC QLQ-C30-FS were significantly higher, and EORTC QLQ-C30-SS scores and BFI scores were remarkably lower.ConclusionEarly prevention of CDT combined with rehabilitation exercise reduced incidence of lower limb extremity lymphedema and improved patients’ quality of life, as well as reduced the cancer-related fatigue.     

Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: a 6-month follow-up study using clinical tests

OBJECTIVE: To investigate the effects of intraarticular hyaluronic acid (HA) (Artzal, Seikagaku Corp., Japan) in geriatric participants with unilateral knee osteoarthritis (OA). METHOD: This was a prospective, observer-blind study with 6 months follow-up done in the setting of an outpatient rehabilitation department in a university-affiliated tertiary care medical center. Sixty-eight patients, aged 65 years or above, with symptoms and radiographic evidence of unilateral knee OA for at least 6 months were recruited. Patients received five weekly intraarticular injections of Artzal into symptomatic knees. Fifty-six participants completed the study. Fifty age-, body mass- and gender-matched healthy individuals were selected as control. Visual analog scale (VAS), Lequesne index and four balance tests including single-leg stance test (SLS), function reach test (FRT), timed "Up-and-Go" test (TUG) and Berg balance scale (BBS) were assessed before injection and at each follow-up visit in the OA group. Four balance tests were obtained on healthy participants for data comparison. RESULTS: Before Artzal injections, the OA group showed significantly worse VAS, Lequesne index and four balance tests scores than did the control group (P < 0.001). Significant improvement in all outcome measures were noted at 1 week, 1, 3 and 6 months post the fifth injection compared with baseline before injection. Local adverse events were reported in four patients (7.1%). CONCLUSION: Significant improvement in pain, physical function and balance tests was demonstrated after five weekly Artzal injections in geriatric patients with knee OA. The effect had rapid onset at 1 week and may last for 6 months.     

Efficacy of Home-Based Kinesthesia,Balance & Agility Exercise Training Among Persons with Symptomatic Knee Osteoarthritis

The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ≥ 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05) improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid-point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach for persons with knee OA.

Key points

• Kinesthesia, balance and agility programs, as well as lower extremity resistance training programs, or a combination of the two appeared equally effective in reducing symptoms of knee osteoarthritis.
• A placebo control intervention also appeared effective, but improvements reached a plateau at mid-point (4 weeks), unlike exercise program improvement which continued between mid-point and follow-up (8 weeks).
• Our results, along with two previous small studies, provide preliminary evidence that kinesthesia, balance, and agility programs without additional resistance training could be effective in treating knee osteoarthritis symptoms.
• Some evidence was found to suggest programs that include resistance training may be more effective for improving function, but more research is needed to confirm or refute this finding.

Key words: Exercise therapy, rehabilitation, postural balance, resistance training     

Effect of whole body cryotherapy on low back pain and release of endorphins and stress hormones in patients with lumbar spine osteoarthritis

IntroductionLow back pain (LBP) is the most common ailment in patients with lumbar spine osteoarthritis (OA). There are many methods to treat LBP, such as manual therapy, osteopathy, massage, physical exercise, and physical therapy. The most effective of these are manual therapy and exercises combined with physical procedures, such as whole body cryotherapy (WBCT). Whole body cryotherapy can induce various hormonal adaptations in patients with OA. This is probably the body’s reaction to cold and stress. The purpose of the study was to evaluate the impact of WBCT on β-endorphins, cortisol and adrenaline release, as well as on LBP in patients with OA of the lumbar spine.Material and methodsThe study group consisted of 30 patients with lumbar spine OA who underwent a series of WBCT combined with therapeutic exercises. Before and after the therapy each patient was examined using a visual analogue scale (VAS) and blood samples were collected for laboratory determinations (ELISA).ResultsAfter WBCT, the decrease in LBP measured by VAS was statistically significant (p < 0.0001). The mean value of blood β-endorphin level increased after the therapy but the difference was statistically insignificant (p = 0.10). The mean value of the plasma level of cortisol after treatment increased and the difference was statistically significant (p = 0.0009). The plasma level of adrenalin after treatment increased slightly, but the difference was statistically insignificant (p = 0.08).ConclusionsWhole body cryotherapy combined with therapeutic exercises had a positive effect on LBP reduction in patients with OA. On the basis of these changes, processes that take place in the nervous and endocrine systems are a response to the stimuli of cold and stress. The mechanism of action of extremely low temperatures on the human body is still not fully understood.     

Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis

STUDY DESIGN: A randomized clinical trial design. OBJECTIVE: To investigate the efficacy of high, repetitive, target-matching foot-stepping exercise (TMFSE) performed in a sitting position on proprioception, functional score, and walking velocity for patients with knee osteoarthritis (OA). BACKGROUND: Researchers have suggested that exercises to address knee OA should include proprioceptive training. However, most patients cannot tolerate conventional proprioceptive training performed in a standing position. METHODS AND MEASURES: Forty-nine subjects (mean age +/- SD, 63.3 +/- 8.1) with knee OA were randomly assigned to the exercise or no intervention groups. The exercise group practiced TMFSE in sitting, 3 sessions weekly for 6 weeks. All subjects underwent assessments of knee reposition error, functional incapacity score, and walking velocity prior to and after intervention. RESULTS: The TMFSE significantly improved reposition error from a mean +/- SD of 3.0 degrees +/- 1.6 degrees to 1.5 degrees +/- 0.6 degree, walking velocity on ground level from 44.1 +/- 2.9 to 38.6 +/- 2.5 sec for 60 meters, time to complete a stairs task from 34.2 +/- 2.1 to 26.5 +/- 2.3 seconds, time to complete a figure-of-eight from 51.3 +/- 6.7 to 29.1 +/- 3.6 seconds, and score on a functional incapacity scale from 12.0 +/- 3.1 to 4.9 +/- 1.7, in subjects with knee OA after 6-week intervention (P <.0125). In contrast, the control group showed no change in any of the measured tests. CONCLUSION: TMFSE in sitting appears to be an option for exercise in patients with mild to moderate knee OA. This may be an especially attractive option for patients who may have pain with weight-bearing exercises. A longitudinal study with a larger sample size is needed to confirm the potential use of TMFSE for patients with knee OA.     

Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization

STUDY DESIGN: One group pretest-posttest exploratory design. OBJECTIVES: Primary purposes of this study were to examine the short-term effect of hip mobilizations on pain and range of motion (ROM) measurements in patients with knee osteoarthritis (OA) and to determine the prevalence of painful hip and squat test findings in both patients with knee OA and asymptomatic subjects. The secondary purposes were to assess intrarater reliability and to determine whether fewer subjects experienced painful test findings following hip mobilization. BACKGROUND: Conservative intervention, including manual physical therapy applied to the lower extremity, has been shown to reduce impairments associated with knee OA. METHODS AND MEASURES: One rater pair administered 4 clinical hip tests to 22 patients with knee OA (mean age, 61.2 years; SD, 6.1 years) and 17 subjects without lower extremity symptoms or known pathology (mean age, 64.0 years; SD, 7.9 years). Intrarater reliability was examined for each clinical test. Patients with knee OA and painful-hip and squat test findings received hip mobilizations. Pain and ROM responses for each test were dependent variables. RESULTS: Intraclass correlation coefficients for all tests were greater than 0.87. Composite and individual test pain scores and ROM scores improved significantly following hip mobilization. All clinical test findings were more frequent in the group with knee OA, except for those of the FABER test, and the number of subjects with painful test findings following hip mobilization was reduced for all tests except the hip flexion test. CONCLUSIONS: Patients experienced increases in ROM, decreased pain, and fewer subjects had painful test findings immediately following a single session of hip mobilizations. Examination and intervention of the hip may be indicated in patients with knee OA.     

A Systematic Review of Conservative Interventions for Osteoarthritis of the Hand

Study DesignSystematic Review.IntroductionHand therapy interventions for patients with hand osteoarthritis (OA) can include splinting, joint protection technique instruction, paraffin, exercises, and provision of a home exercise program.PurposeExamine the quality of the evidence regarding the hand therapy interventions for hand OA.MethodsTwenty-one studies dated between 1986 and 2009 were included in the systematic review for analysis.ResultsThe current evidence provides varied support for the interventions of orthotics, hand exercises, joint protection techniques, the utilization of adaptive devices, and paraffin. Findings for the use of joint protection techniques are supported for improvements in function and pain reduction. Minimal evidence exists for paraffin used for the treatment of hand OA.ConclusionsThe current literature supports the use of orthotics, hand exercises, application of heat, and joint protection education combined with provision of adaptive equipment to improve grip strength and function.Level of Evidence2A.     

Short- and medium-term effects of manual therapy on the upper cervical spine combined with exercise vs isolated exercise in patients with cervicogenic headache. A randomized controlled trial

BackgroundCervicogenic headache is defined as a unilateral headache associated with a lack of range of motion. The effect of manual therapy applied to the upper cervical spine combined with cervical exercises in this patient population is currently unknown.ObjectiveTo determine if adding manual therapy to an exercise and home-exercise program is more effective by reducing symptoms and improving function in the short- and mid-term than just applying exercises in patients with cervicogenic headache.MethodsRandomized controlled trial. 40 participants with cervicogenic headache were recruited (20 = Manual Therapy + Exercise and 20 = Exercise). Each group received four 20-min sessions weekly and a home exercise regime. Upper cervical flexion and flexion-rotation test, HIT-6, headache intensity, craniocervical flexion test, pain pressure thresholds, GROC-scale, and adherence to self-treatment were measured at the beginning and end of the intervention, and again at 3-(short-term) and 6-month (mid-term) follow-ups.ResultsThe Manual Therapy + Exercise group showed a statistically significant improvement in all short- and mid-term variables (p < .05) compared to the exercise group except for the variable pain pressure thresholds first metacarpal joint right and left short-term and adherence to self-treatment short-term.ConclusionFour 20-min sessions of manual therapy and an exercise protocol along with a home exercise regime is more effective in the short and mid-term than an exercise protocol and a home exercise regime for patients with cervicogenic headache.     

Comparison of anemia,renal function,and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint

BackgroundSeveral studies in older patients with femoral neck fracture found that preoperative anemia and malnutrition were associated with higher mortality and poorer physical function. Therefore, we compared nutritional status, Hb level, and renal function in women with femoral neck fracture and women of the same age with osteoarthritis of the hip joint.MethodsWe enrolled 257 women aged 70 years and older who suffered femoral neck fracture (F group) or who were scheduled to undergo total hip arthroplasty for osteoarthritis of the hip joint (OA group). The F and OA groups were further divided into 2 groups on the basis of age, ie, 74 years old and younger (F70 and OA70) and 75 years old and older (F75 and OA75). To assess whether patients had undernutrition, mortality risk, anemia, and renal dysfunction, we assessed Geriatric Nutritional Risk Index (GNRI), Hb, and eGFR.ResultsWe found a significant difference in the mean Hb levels and GNRI scores between the F75 and OA75 and F70 and OA70. Moreover, we found a moderate correlation between Hb level and GNRI score in the F75 and OA75. With respect to the GNRI category, the percentage of patients at moderate or major risk was 42.1% in the F70 group and 57.6% in the F75 group but only 1.9% in the OA70 group and 4.3% in the OA75 group.ConclusionWe found that women with femoral neck fracture had significantly lower Hb levels and lower GNRI scores than women with hip OA in the same age and that anemia and undernutrition were closely linked in women aged 75 and above. Moreover, we found that more than 40% of patients with a femoral neck fracture had a moderate to major risk on the basis of their GNRI scores.     

Effects of strengthening the hip flexor muscles on walking ability and the locomotive syndrome rank test: An intervention study

BackgroundLocomotive syndrome is a state in which locomotive function is decreased due to musculoskeletal diseases. To extend a healthy lifespan, it is important to prevent falls and locomotive syndrome development accompanying aging by slowing the decline in walking ability. However, it is unclear whether hip flexor muscle strengthening improves walking ability and locomotive syndrome. This study aimed to examine the effect of hip flexor muscle strengthening on walking ability and the locomotive syndrome rank test.MethodsForty participants were enrolled. Before hip flexor muscle strengthening, maximum muscle strength on the exercised side was measured, and gait analysis and the two-step test were performed simultaneously. Participants were divided into a healthy group and a locomotive syndrome group based on the two-step test and were given hip flexor muscle training at least three days a week for six weeks. After completing the training, maximum muscle strength was measured and gait analysis was performed for all participants. The difference between the two-step test conducted pre- and post-training in the locomotive syndrome group was statistically analyzed.ResultsTwenty-two and 14 participants were included in the healthy and the locomotive syndrome groups, respectively. Hip flexion strength on the exercised side increased from 1.68 to 1.95 Nm/kg (p < 0.0001) and 1.04 to 1.21 Nm/kg (p = 0.0031) in the healthy and the locomotive syndrome groups, respectively. Step length, stride length and walking speed measured by gait analysis also increased in both groups. Consequently, the two-step test score improved from 1.17 to 1.30 (p = 0.0002) and the stage of locomotive syndrome improved in 9 participants (p = 0.041).ConclusionsStrengthening of the hip flexor muscles improved walking ability and the stage of locomotive syndrome. Therefore, strengthening of the hip flexor muscles is important for the prevention and improvement of locomotive syndrome.     

Relationship of Bone Mineral Density and Knee Osteoarthritis (Kellgren-Lawrence Grade): Fifth Korea National Health and Nutrition Examination Survey

BackgroundOsteoarthritis (OA) and osteoporosis (OP) are the 2 most common bone disorders associated with aging. We can simply assume that older patients have a higher incidence of OA and OP with more severity. Although several papers have conducted studies on the relationship between OA and OP, none of them has demonstrated a conclusive link. In this study, we used radiological knee OA and bone mineral density (BMD; T-score of the total hip and lumbar spine) to analyze the incidence of OA and OP in a large population. We aimed to determine the relationship between OA and OP and investigate the associated risk factorsMethodsThis cross-sectional study used data extracted from the 2010–2012 Korea National Health and Nutrition Examination Survey. We evaluated a total of 4,250 participants aged ≥ 50 years who underwent knee radiography and dual-energy X-ray absorptiometry and their laboratory results. The relationship between radiological knee OA and BMD was assessed. The generalized linear model was used to evaluate the relationship between BMD and Kellgren-Lawrence (KL) grade.ResultsThe higher KL grade was associated with older age, higher body mass index (BMI), female sex, and lower hemoglobin level (p < 0.001). No significant association was found between OA and the following variables: white blood cell, platelet, total cholesterol, vitamin D, alkaline phosphatase, parathyroid hormone, hypertension, diabetes, asthma, dyslipidemia, smoking status, alcohol consumption, and regular exercise (p > 0.05). After adjusting for confounding factors (age, BMI, diabetes, hypertension, smoking, and alcohol consumption), the average T-scores of total hip and lumbar spine were the highest in the mild OA group with KL grade 2 (−0.22 ± 1.08 and −0.89 ± 1.46, respectively, p < 0.001). The average T-scores of the total hip and lumbar spine significantly decreased as OA progressed from moderate (KL grade 3; −0.49 ± 1.05 and −1.33 ± 1.38, respectively, p < 0.001) to severe (KL grade 4; −0.73 ± 1.13 and −1.74 ± 1.75, respectively, p < 0.001). T-scores of the moderate-to-severe OA group were significantly lower than those of the non-OA group (KL grades 0 and 1, p < 0.001).ConclusionsCompared with the non-OA group, BMD (T-scores of the total hip and lumbar spine) was higher in the mild OA group and lower in the moderate-to-severe OA group.     

Spatial Heterogeneity in the Response of the Proximal Femur to Two Lower‐Body Resistance Exercise Regimens

Understanding the skeletal effects of resistance exercise involves delineating the spatially heterogeneous response of bone to load distributions from different muscle contractions. Bone mineral density (BMD) analyses may obscure these patterns by averaging data from tissues with variable mechanoresponse. To assess the proximal femoral response to resistance exercise, we acquired pretraining and posttraining quantitative computed tomography (QCT) images in 22 subjects (25–55 years, 9 males, 13 females) performing two resistance exercises for 16 weeks. One group (SQDL, n = 7) performed 4 sets each of squats and deadlifts, a second group (ABADD, n = 8) performed 4 sets each of standing hip abductions and adductions, and a third group (COMBO, n = 7) performed two sets each of squat/deadlift and abduction/adduction exercise. Subjects exercised three times weekly, and the load was adjusted each session to maximum effort. We used voxel‐based morphometry (VBM) to visualize BMD distributions. Hip strength computations used finite element modeling (FEM) with stance and fall loading conditions. We used QCT analysis for cortical and trabecular BMD, and cortical tissue volume. For muscle size and density, we analyzed the cross‐sectional area (CSA) and mean Hounsfield unit (HU) in the hip extensor, flexor, abductor, and adductor muscle groups. Whereas SQDL increased vertebral BMD, femoral neck cortical BMD and volume, and stance hip strength, ABADD increased trochanteric cortical volume. The COMBO group showed no changes in any parameter. VBM showed different effects of ABADD and SQDL exercise, with the former causing focal changes of trochanteric cortical bone, and the latter showing diffuse changes in the femoral neck and head. ABADD exercise increased adductor CSA and HU, whereas SQDL exercise increased the hip extensor CSA and HU. In conclusion, we observed different proximal femoral bone and muscle tissue responses to SQDL and ABADD exercise. This study supports VBM and volumetric QCT (vQCT) to quantify the spatially heterogeneous effects of types of muscle contractions on bone. © 2014 American Society for Bone and Mineral Research.