Exploring the impact of integrated polyvagal exercises and knee reinforcement in females with grade II knee osteoarthritis: a randomized controlled trial

Abstract

This study aimed to compare the effects of knee strengthening exercises to those of polyvagal theory–based exercises combined with knee strengthening exercises on selected outcomes in women with grade II knee osteoarthritis (OA). A randomized controlled trial was conducted, in which 60 female participants diagnosed with grade II knee OA, with a mean age of 57.27 ± 7.81 years and knee pain rated between 4 and 7 on the visual analog scale (VAS), were assigned to either the knee strengthening exercise group (Group 1, n = 30) or the polyvagal theory–based exercise plus knee strengthening exercise group (Group 2, n = 30). Pre- and posttreatment assessment of outcome variables, including WOMAC scores (joint pain, joint stiffness, functional limitations, and the overall index), WHOQOL scores (overall quality of life, general health, physical, psychological, social, and environmental domains), and heart rate variability (HRV, time and frequency domains), were analyzed. Group 2 demonstrated significantly greater reductions in joint pain, stiffness, and functional limitations than Group 1 after the intervention. Group 2 presented with significantly improved WOMAC scores, indicating better overall outcomes. Group 2 showed significant improvements in the psychological and social domains regarding quality of life. There were no significant differences in the physical domain or the environmental domain. Group 2 showed a significant increase in high-frequency power (HF) and a significant decrease in the LF/HF ratio, suggesting improved autonomic regulation. A combination of polyvagal exercise and knee strengthening training resulted in superior outcomes compared to knee strengthening exercises alone in women with grade II knee OA. These findings support the potential effectiveness of incorporating polyvagal exercises as an adjunctive intervention for osteoarthritis management.

Vagotomy accelerates the onset of symptoms during early disease progression and worsens joint-level pathogenesis in a male rat model of chronic knee osteoarthritis

“…Several reviews have highlighted the need to characterize crosstalk between the ANS and joint in OA pathophysiology [ 2 , 3 , 9 ]. Additionally, several clinical reports have explored the potential therapeutic effects of increasing vagal tone on OA [ 31 , 33 , 34 ]. However, no study has evaluated how low vagal tone influences disease progression in a rodent model of chronic OA.…”

“…For example, low vagal tone is associated with several OA comorbidities such as diabetes [ 17 , 18 ], hypertension [ [19] , [20] , [21] ], obesity [ [22] , [23] , [24] ] and risk factors such as physical inactivity [ [25] , [26] , [27] , [28] ] and aging [ 20 , 29 , 30 ]. Additionally, increasing vagal tone via vagus nerve stimulation has alleviated symptoms in individuals with erosive hand OA [ 31 ] and has been suggested as a potential treatment strategy for OA [ [32] , [33] , [34] ]. Several mechanisms may be involved in the potential therapeutic effects of vagus nerve stimulation such as the activation of the cholinergic and splanchnic anti-inflammatory pathways [ 13 , 14 ], modulation of immunomodulatory cortisol levels [ 15 , 16 ], or disrupting the transmission of pain signaling [ 35 ].…”