What type of exercise is most effective for people with knee osteoarthritis and co-morbid obesity?: The TARGET randomized controlled trial

Abstract

Objective: Different exercise types may yield different outcomes in osteoarthritis (OA) subgroups. The objective was to directly compare effectiveness of two exercise programs for people with medial knee OA and co-morbid obesity. Design: We performed a participant-and assessor-blinded randomized controlled trial. 128 people !50 years with medial knee OA and body mass index !30 kg/m 2 were recruited from the community. Interventions were home-based non-weight bearing (NWB) quadriceps strengthening or weight bearing (WB) functional exercise for 12 weeks. Primary outcomes were change in overall knee pain (numeric rating scale, range 0e10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0e68) over 12 weeks. Secondary outcomes included other pain measures, physical function, quality-of-life, global changes, physical performance, and lower-limb muscle strength. Results: 123 (96%) participants were retained. There was no evidence of a between-group difference in change in pain (mean difference 0.73 units (95% confidence intervals (0.05,1.50)) or function (2.80 units (À1.17,6.76)), with both groups reporting improvements. For secondary outcomes, the WB group had greater improvement in quality-of-life (À0.043 units (À0.085,-0.001)) and more participants reporting global improvement (overall: relative risk 1.40 (0.98,2.01); pain 1.47 (0.97,2.24); function 1.43 (1.04,1.98). Although adverse events were minor, more NWB group participants reported !1 adverse event (26/66 (39%) vs 14/62 (23%), p ¼ 0.04). Conclusions: Both exercise types similarly improved primary outcomes of pain and function and can be recommended for people with knee OA and obesity. WB exercise may be preferred given fewer adverse events and potential additional benefits on some secondary outcomes.

Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial

“…Despite greater adherence to home exercise in the SMS group, we found no between-group difference in any secondary clinical outcome. Both groups either maintained or had slight diminution of the clinical improvements resulting from the preceding 12-week physiotherapist-supervised exercise phase (TARGET trial) [ 24 ]. This lack of further improvement may relate to inadequate exercise progression, including suboptimal intensities, during this unsupervised phase.…”

“…This trial used participants completing another study, the TARGET trial [ 24 ], where participants visited a physiotherapist five times over 12 weeks for prescription of either a weight-bearing functional exercise program or a non–weight-bearing quadriceps strengthening exercise program. TARGET trial participants were recruited from the community in Melbourne, Australia, between September 2017 and May 2019 via advertisements through consumer organizations, social media, community locations, media, and our volunteer database.…”

“…All participants were asked to continue their allocated TARGET prescribed home exercise program unsupervised for 24 weeks [ 24 ] but to reduce the frequency from four times per week to three times per week ( Multimedia Appendix 2 ). The frequency was reduced to facilitate adherence over the longer term while still meeting exercise guideline recommendations [ 25 ].…”

Challenges With Strengthening Exercises for Individuals With Knee Osteoarthritis and Comorbid Obesity: A Qualitative Study With Patients and Physical Therapists

“…There is also some existing evidence that people with OA who are obese may experience different barriers to different types of strengthening programs. For example, our recent randomized controlled trial (RCT) found higher rates of adverse events in individuals with OA and comorbid obesity who completed a non-weight-bearing exercise program (39% of 66 participants reported an adverse event), compared to a weight-bearing functional exercise program (23% of 62 participants) (20). However, it is not clear why this is or what barriers individuals with OA who are obese face when engaging in such strengthening exercise programs.…”

Exercise and education for community-dwelling older participants with knee osteoarthritis: a video-linked programme protocol based on a randomised controlled trial

“…The exercise testing plan and exercise prescription are based on findings from previous studies [39][40][41]. In detail, the neuromuscular exercises will progress in difficulty monthly, and the quadriceps exercises will progress in resistance and in the number of sets weekly from the third training, which will be determined according to a participant's pain (defined as an average pain score ≥ 4, on an 11-point numerical pain rating scale (NPRS) [42] during exercise) and perceived exertion (defined as an average exertion between 5 and 8, on an 11-point modified rating perceived exertion scale [43] during exercise).…”