Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial

Abstract

BackgroundOver the last decade aquatic exercise has become more and more popular. One of the latest trends is aqua-cycling, where participants sit on a water-resistant stationary bike and, while immersed chest deep in the water, combine continuous cycling with upper body exercises that utilise water resistance. Since stationary cycling and aquatic exercises are frequently recommended to patients with knee osteoarthritis, combining both would seem an obvious step, and an aqua-cycling exercise programme for patients with knee osteoarthritis has indeed been developed. This study protocol gives a detailed description of the exercise programme and the methodology of a study to compare this programme with treatment involving usual care only.MethodsThe study is a single-blind, parallel-group, randomised controlled trial of Maastricht University Medical Centre+, the Netherlands. Inclusion criteria: knee pain of four to seven on a 10-point pain rating scale; a Kellgren/Lawrence score between one to three; ability to cycle; good mental health; sufficient language skills; indication for physical therapy in conjunction with impairments due to OA. Exclusion criteria: any contra-indication for aquatic exercise; planned total knee replacement; corticosteroid injection <3 months and/or hyaluronic acid injection <6 months; severe joint complaints (other than knee joint); symptomatic and radiological apparent hip OA; inflammatory joint diseases; inability to safely enter and exit the pool; fear of water. Participants will receive two 45-min moderate intense aqua-cycling sessions weekly over a period of 12 weeks in addition to usual care or usual care only. Usual care consists of an individual intervention plan comprising lifestyle recommendations, medication routine and referral to a physical therapist. Participants will be assessed at baseline, and at 12 and 24 weeks after baseline. The primary outcome is self-reported knee pain and physical functioning. Secondary outcomes are lower limb muscle strength, functional capacity, self-reported disease severity, physical activity level, quality of life, self-efficacy and fear of movement. Daily diaries will collect information on knee pain, physical functioning, level of physical activity, pain medication routine and physical therapy (control group only) or exercise participation over two 30-day periods (during the intervention period).DiscussionTo our knowledge the present study is the first randomised controlled trial evaluating the effects of aqua-cycling in the pre-surgical stage of knee osteoarthritis. This trial will demonstrate if the newly designed aqua-cycling intervention, in supplement to usual care, can help to improve impairments due to knee osteoarthritis.Trial registrationNetherlands Trial Register NTR3766 (21-12-2012).Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0939-5) contains supplementary material, which is available to authorized users.

Impact of resistance exercises and nano-curcumin on synovial levels of collagenase and nitric oxide in women with knee osteoarthritis

“…Nitric Oxide (NO) is extremely unstable and undergoes rapid oxidative degradation to stable nitrite (NO2-) and nitrate (NO3-), which react with the colorant and produce azo-pink composition and is quantified spectrophotometrically [27]. Serum levels of metabolites were measured by colorimetric Griess assay.…”

The effect of aquatic exercise program on low-back pain disability in obese women

“…It was concluded the static stretching of the hamstrings, calf, and upper and lower back muscles; 10-25 m front, back and sideways walking; 10-25 m front jogging; 15-20 m with self-chosen speed, forward and side lunges, leg pedaling and cycling in supine position; self-chosen repetition, upper body mobilization and shoulder transvers exercise. Each exercise was repeated in three sets in each session (Olson et al, 2013;Rewald et al, 2016). The whole session required about 60 min, which 10 min of warm-up, 40-min aquatic exercise, 5 min of cool-down and relaxation exercises, and 5-min self-care free water-activity were considered for each session of exercise (Fisken et al, 2015).…”

“…In this depth of water, the participants performed the exercises (walking, jogging, pedaling, cycling, and relaxation) with swimming woggles, as the aid equipment. The conditioning of intensity was considered 13-17 Borg Scale (60%-70%) of their maximum heart rate (Rewald et al, 2016).…”

Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people

“…Analgesic medications such as non-steroidal anti-inflammatory drugs and glucocorticoids are also prescribed frequently to palliate the symptoms and reduce inflammation [9,10]. However, central to the recommended treatments is the use of exercise to maintain general health, to recover function, and to decrease the likelihood of the disease progression [2,[11][12][13].…”

“…Water buoyancy causes the patients to move more comfortably and less painfully than on the land. In addition, warm water provides more muscle relaxation and symptom palliation [11,14,15].…”