A Biomechanical Exercise Program for Knee OA

McMaster University

Status: Completed

Conditions: Osteoarthritis, Knee

Treatments: Other: Biomechanical Exercise (BE); Other: Meditation Control (M); Other: Traditional Exercise (TE)

Study type: Interventional

Funder types: Other

Identifiers

NCT02370667

BiomechanicalExerciseProgram

Details and patient eligibility

About

Prescribing exercise for people with painful knee osteoarthritis (OA) is essential for pain management, improved function, and chronic disease prevention. Exercise that decreases joint exposure to damaging loading while eliciting adequate muscular activation for strength improvements is ideal. The purpose of this 3-arm RCT is to compare mobility, strength, pain, and MRI outcomes between the low-loading biomechanical exercise program (BE), a traditional exercise program for knee OA (TE), and a control group completing meditation classes (M).

Full description

Osteoarthritis (OA) is a common joint disease affecting 1 in 10 Canadians. Osteoarthritis commonly presents in the knee joint and is associated with mobility limitations, pain, and an increased risk of other chronic health conditions such as heart disease. It is critical to implement exercise for people with knee OA as it can be an effective method for improving pain, mobility, and cardiovascular health. A biomechanical exercise program using static yoga postures has been established in the investigators lab based on minimizing damaging knee joint loads, while effectively exercising the musculature around the knee joint. The investigators pilot project (REB#13-510) showed that a 12-week yoga program using these biomechanical exercises improved pain and mobility while keeping the medial joint loading well below that experienced during normal level walking. The next step with this exercise program is to compare clinical and tissue outcomes with that of a regularly prescribed aerobic and strengthening program, as well as a control group completing meditation classes. The investigators aim to identify differences in clinical mobility performance outcomes, muscle and fat volumes using magnetic resonance imaging (MRI), and cartilage integrity using MRI between the three groups using a randomized controlled trial (RCT) design.

Enrollment: 31 patients

Sex: Female

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 50 years of age or older
• Knee pain on most days of the week
• Less than 30 minutes of morning stiffness
• Bony enlargement
• Bony tenderness to palpation
• Signs of inflammation
• Able to safely climb 2 flights of stairs without aid

Exclusion criteria

• Any other forms of arthritis
• Osteoporosis
• History of patellofemoral symptoms
• Active non-arthritic knee disease
• Knee surgery
• Use of cane or walking aid
• Unstable heart condition
• Neurological conditions
• Skin allergy to medical tape
• Hip or ankle injuries in past 3 months
• Any injuries that would prohibit participation in yoga
• Ipsilateral hip or ankle conditions
• Currently receiving cancer treatment
• Currently pregnant

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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31 participants in 3 patient groups

Biomechanical Exercise (BE)

Experimental group

Description:

The participants in this arm will be asked to attend 3 group classes per week for 12 weeks at a local yoga studio taught by a certified yoga instructor. Four class times will be offered per week. These classes will include a warm-up, static poses shown to decrease knee joint loading, and a cool down including flexibility exercises. Measurements will be obtained at baseline (before intervention) and at follow-up (following intervention). Outcomes will include clinical mobility; muscle and fat volumes, and cartilage morphology using MRI; pain; isometric leg strength; cardiovascular fitness; and gait analysis.

Treatment:

Other: Biomechanical Exercise (BE)

Traditional Exercise (TE)

Active Comparator group

Description:

The participants in this arm will be prescribed an aerobic and strengthening exercise program often prescribed to those with knee OA. The program will include 15 minutes of walking per class, closed kinetic chain strengthening exercises on machines, and a cool down consisting of stretching. Participants will be asked to come to class 3 times per week for 12 weeks. Certified Kinesiologists as well as student volunteers will be available during all class times for program completion and progression.

Treatment:

Other: Traditional Exercise (TE)

Meditation Control (M)

Other group

Description:

The participants in this arm will be asked to attend 3 meditation classes per week for 12 weeks taught by a certified yoga instructor with a specialization in meditation. This will take place at an alternate yoga studio to avoid contamination. Since it is known that exercise is beneficial for pain management and strengthening in knee OA, participants randomized to the control group will be offered a free exercise pass following completion of the study.

Treatment:

Other: Meditation Control (M)