Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis

ObjectivesWe systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.Data sourcesPubMed, CINAHL, Scopus; inception to January 2019.Eligibility criteriaRandomised clinical trials (RCT), cohort studies, case series.DesignWe summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.ResultsInterventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.ConclusionsIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.PROSPERO registration numberCRD42018087859.

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The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210043 ◽

2021 ◽

pp. 1-6

Author(s):

Kun Yung Kim ◽

Gi-Wook Kim

Keyword(s):

Conservative Treatment ◽

Knee Osteoarthritis ◽

Knee Pain ◽

Transcatheter Arterial Embolization ◽

Rating Scale ◽

Case Series ◽

Arterial Embolization ◽

Numeric Rating Scale ◽

Knee Oa ◽

Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

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Resistance and aerobic exercise protects against acute endothelial impairment induced by a single exposure to hypertension during exertion

Journal of Applied Physiology ◽

10.1152/japplphysiol.00438.2010 ◽

2011 ◽

Vol 110 (4) ◽

pp. 1013-1020 ◽

Cited By ~ 58

Author(s):

Shane A. Phillips ◽

Emon Das ◽

Jingli Wang ◽

Kirkwood Pritchard ◽

David D. Gutterman

Keyword(s):

Blood Pressure ◽

Resistance Exercise ◽

Aerobic Exercise ◽

Vascular Function ◽

Cardiovascular Health ◽

Weight Lifting ◽

Acute Hypertension ◽

Before And After ◽

Weight Lifters ◽

Blood Pressure Responses

Resistance and aerobic exercise is recommended for cardiovascular health and disease prevention. However, the accompanying increase in arterial pressure during resistance exercise may be detrimental to vascular health. This study tests the vascular benefits of aerobic compared with resistance exercise on preventing impaired vascular function induced by a single weight lifting session that is associated with acute hypertension. Healthy, lean sedentary (SED) subjects, weight lifters, runners (>15 miles/wk), and cross trainers (chronic aerobic and resistance exercisers), underwent a single progressive leg press weight lifting session with blood pressure measurements. Brachial artery flow-mediated vasodilation (FMD; an index of arterial endothelial function) was determined using ultrasonography immediately before and after weight lifting. Sublingual nitroglycerin (0.4 mg) was used to determine endothelium-independent dilation after weight lifting. All subjects were normotensive with similar blood pressure responses during exercise. Baseline FMD was lower in runners (5.4 ± 0.5%; n = 13) and cross trainers (4.44 ± 0.3%; n = 13) vs. SED (8.5 ± 0.8%; n = 13; P = 0.037). Brachial FMD improved in conditioned weight lifters (to 8.8 ± 0.9%; P = 0.007) and runners (to 7.6 ± 0.6%; P < 0.001) but not cross trainers (to 5.3 ± 0.6%; P = NS) after acute hypertension. FMD was decreased in SED (to 5.7 ± 0.4%; P = 0.019). Dilation to nitroglycerin was similar among groups. These data suggest that endothelial responses are maintained after exposure to a single bout of weight lifting in resistance and aerobic athletes. Resistance and aerobic exercise may confer similar protection against acute vascular insults such as exertional hypertension.

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Exploring Physical Therapist Adherence to Clinical Guidelines When Treating Patients With Knee Osteoarthritis in Australia: A Mixed Methods Study

Physical Therapy ◽

10.1093/ptj/pzaa049 ◽

2020 ◽

Vol 100 (7) ◽

pp. 1084-1093

Author(s):

Clarice Y Tang ◽

Rebecca Pile ◽

Anna Croft ◽

Narelle J Watson

Keyword(s):

Pain Management ◽

Knee Osteoarthritis ◽

Aerobic Exercise ◽

Clinical Guidelines ◽

Physical Therapists ◽

Physical Therapist ◽

Structured Interview ◽

Main Theme ◽

Range Of Movement ◽

Knee Oa

Abstract Objective The authors aimed to understand how physical therapists used practice guidelines to manage patients with knee osteoarthritis (OA) in Australia. Methods This study used a concurrent triangulation mixed-method approach to explore how physical therapists applied clinical guidelines when managing patients with knee OA in an outpatient setting via completion of a semi-structured interview. Interviews were thematically analyzed by 2 investigators using an inductive approach. Themes were then triangulated to the results of an audit that evaluated the level of adherence to respective areas in the clinical guidelines among physical therapists at the participating site. Results One main theme and 3 subthemes were identified from 18 participants: (1) physical therapists were most confident in applying guidelines to improving range of movement and strength; (2) lack of knowledge in prescription of aerobic exercise, weight, and pain management; (3) pain is a bigger barrier in areas where knowledge is lacking; and (4) lack of clarity around the scope of practice. Themes converged with the reported level of adherence to guidelines. Conclusions Physical therapists commonly include range of movement and muscle strength exercises when managing people with knee OA. However, they were less confident in prescribing aerobic exercise and recommending weight and pain management strategies. Impact Apart from the need to upskill physical therapists in the aforementioned areas of clinical practice, the role of a physical therapist in the management of people with knee OA requires further clarification.

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Preliminary Evaluation of a New Orthotic for Patellofemoral and Multicompartment Knee Osteoarthritis

Rehabilitation Research and Practice ◽

10.1155/2021/5923721 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Aleksandra R. Budarick ◽

Emily L. Bishop ◽

Marcia L. Clark ◽

Christopher D. Cowper-Smith

Keyword(s):

Physical Activity ◽

Knee Osteoarthritis ◽

Physical Function ◽

Outcome Measures ◽

Case Series ◽

Secondary Outcome ◽

Preliminary Evaluation ◽

Activity Levels ◽

Knee Oa ◽

Before And After

Purpose. Traditional knee osteoarthritis (OA) braces are usually indicated for a minority of patients with knee OA, as they are only suitable for those with unicompartmental disease affecting the tibiofemoral joint. A new assistive brace design is intended for use in a wider range of knee OA patients with heterogeneous symptoms characteristic of patellofemoral, tibiofemoral, or multicompartmental knee OA. The purpose of this case series was to explore whether the use of this novel “tricompartment offloader” (TCO) brace was associated with clinically relevant improvements in pain and function. Materials and Methods. A retrospective analysis of individuals with knee OA ( n = 40 ) was conducted to assess pain, function, physical activity, and use of medication and other treatments before and after brace use. Validated outcome measures including the Visual Analog Scale (VAS) and Lower Extremity Functional Scale (LEFS) were used to assess pain and physical function (primary outcome measures). Exploratory measures were used to quantify physical activity levels and use of medication and other treatments (secondary outcome measures). Results. Average total pain (VAS) scores decreased by 36.6 mm and physical function (LEFS) scores increased by 16.0 points following the use of the TCO brace. Overall, 70% of the participants indicated increased weekly physical activity and 60% reported a decrease in their use of at least one other treatment. Conclusions. Results from this case series suggest that the TCO brace shows strong potential to fill a conservative treatment gap for patients with heterogeneous symptoms of knee OA that are characteristic of patellofemoral or multicompartment disease. Further investigation is warranted.

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Early Efficacy of Intra-Articular HYADD® 4 (Hymovis®) Injections for Symptomatic Knee Osteoarthritis

Joints ◽

10.1055/s-0037-1603677 ◽

2017 ◽

Vol 05 (02) ◽

pp. 079-084 ◽

Cited By ~ 8

Author(s):

Ferdinando Priano

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Case Series ◽

Womac Score ◽

Clinical Effects ◽

Retrospective Case ◽

Level Of Evidence ◽

Knee Oa ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

Purpose The aim of the study was to evaluate the clinical effects of HYADD® 4, an hydrogel based on a hyaluronic acid derivative, in patients with symptomatic knee osteoarthritis, on symptoms, and joint function. Methods This retrospective study of patients with Kellgren–Lawrence grade II to IV knee osteoarthritis (American College of Rheumatology criteria) enrolled patients who had received two infiltrations of HYADD® 4, (24 mg/3 mL) 1 week apart, and evaluated: pain at rest, pain with movement, change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score; change in nonsteroidal anti-inflammatory drugs (NSAIDs)/acetaminophen use; satisfaction with therapy; tolerability. Study duration was 6 months for all predefined endpoints, with a 6-month extension for pain symptoms only. Results After 6 months, all predefined endpoints were evaluable in 698 of 937 enrolled patients (74.5%). Mean WOMAC scores were reduced by 56.3% from baseline (p < 0.05). NSAIDs/acetaminophen use ≥2 times/week (48.8% of patients at baseline) was substantially reduced after 1 month and was 19.6% after 6 months. After 6 months, 85.6% of patients were satisfied about efficacy. There were no significant adverse effects. The effect on resting pain was rapid, strong, and lasting: reduction from baseline was 45.1% at 1 month (p < 0.05), 56.8% at 6 months (p < 0.05), and 53.6% at 12 months (p < 0.05). Pain on moving was reduced by 47.4% after 6 months (p < 0.05) and 46.0% after 12 months (p < 0.05), results at 6 and 12 months were similar. Conclusion HYADD® 4 is a new-generation hyaluronic acid with distinctive viscoelastic and rheological properties. In patients with mild-to-severe knee OA (Kellgren–Lawrence grades II–IV), two consecutive infiltrations 1 week apart reduced WOMAC scores and NSAIDs/acetaminophen consumption for at least 6 months. In a subpopulation (n = 106), efficacy on pain lasted approximately 12 months. Adverse events were reported in 11.2% of patients; the most frequent were arthralgias. No cases of allergic reactions or systemic effects were recorded. Level of Evidence Level IV, retrospective case series.

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The effect of aerobic exercise training on postmenopausal patients with knee osteoarthritis

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-191712 ◽

2020 ◽

Vol 33 (6) ◽

pp. 995-1002

Author(s):

Filiz Kılıç ◽

Arzu Demirgüç ◽

Saniye Aydoğan Arslan ◽

Esra Dilek Keskin ◽

Müyesser Aras

Keyword(s):

Treatment Group ◽

Exercise Training ◽

Knee Osteoarthritis ◽

Aerobic Exercise ◽

Exercise Program ◽

Aerobic Exercise Training ◽

Performance Tests ◽

Walk Test ◽

Knee Oa ◽

Physiotherapy Program

BACKGROUND: Knee osteoarthritis (OA) is a common musculoskeletal problem encountered in the postmenopausal period. OBJECTIVE: This study aimed to determine the impact of aerobic exercise on functional limitation, exercise tolerance, and performance tests in postmenopausal women with knee OA. METHODS: A total of 50 women (aged between 48–78) with grade 2–3 knee OA according to the Kellgren-Lawrence radiographic scale were enrolled. OA-specific physical performance tests (40 m Fast-Paced Walk Test (40mFPWT), 30 s Chair Stand Test (30sCST), Stair Climb Test (9-step SCT)), six-minute walk test (6MWT), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS) were performed. Fifty patients were randomized to either the treatment or control groups. The treatment group received an additional aerobic exercise training along with a combined physiotherapy program for six weeks. The aerobic exercise program was carried out by the same physiotherapist every weekday (five days) for six weeks. The control group only received a combined physiotherapy program for six weeks. RESULTS: The post-treatment comparisons of the two groups yielded similar SCT results (p> 0.05), while VAS scores, the results of all performance tests, WOMAC scores, and the distance covered in 6MWT were significantly higher in the treatment group (p< 0.05). CONCLUSIONS: Consequently, this study provides an insight into the efficacy of the aerobic exercise program applied along with a combined physiotherapy program in postmenopausal women with knee OA.

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Effectiveness of Exercise Interventions in Reducing Pain Symptoms among Older Adults with Knee Osteoarthritis: A Review

Journal of Aging and Physical Activity ◽

10.1123/japa.14.2.212 ◽

2006 ◽

Vol 14 (2) ◽

pp. 212-235 ◽

Cited By ~ 36

Author(s):

Brian C. Focht

Keyword(s):

Older Adults ◽

Knee Osteoarthritis ◽

Strength Training ◽

Critical Evaluation ◽

The United States ◽

Activity Restriction ◽

Exercise Interventions ◽

Knee Oa ◽

Pain Symptoms

Knee osteoarthritis (OA) affects approximately one third of older adults in the United States. The pain accompanying its progression reduces quality of life and leads to activity restriction and physical disability. Evidence suggests that exercise represents a promising treatment for pain among older knee-OA patients. The article provides an overview of the extant research examining the effectiveness of exercise interventions in reducing pain symptoms among older adults with knee OA. Critical evaluation of the literature reveals that aerobic training, strength training, and combination aerobic and strength training result in improvements in pain. The magnitude of pain reduction accompanying exercise interventions varies considerably across studies, however. In addition, most trials have focused on short-term (<6 months) interventions, and the limited number of long-term (>6 months) trials have been plagued by high attrition and poor postintervention maintenance of treatment effects. Given the variability in the effectiveness of exercise interventions, future research is necessary to determine the individual differences that influence older OA patients’ responsiveness to exercise interventions and identify more efficacious strategies for promoting the maintenance of long-term exercise.

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Aerobic exercise improves hippocampal blood flow for hypertensive APOE4 carriers

10.1101/2020.09.23.20199042 ◽

2020 ◽

Author(s):

Carolyn S Kaufman ◽

Robyn A Honea ◽

Joseph Pleen ◽

Rebecca J Lepping ◽

Amber Watts ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Aerobic Exercise ◽

Genetic Risk ◽

Significant Interaction ◽

Exercise Intervention ◽

Secondary Outcome ◽

Control Group ◽

Carrier Status ◽

Exercise Interventions

Background: Evidence increasingly suggests cerebrovascular dysfunction plays an early and important role in the pathogenesis of Alzheimer′s disease (AD). Studies have shown the strongest known genetic risk factor for sporadic AD, Apolipoprotein E4 (APOE4), may act synergistically with vascular risk factors to promote dementia development. Aerobic exercise may attenuate cognitive decline at least partially through improvements in cerebral blood flow. Therefore, exercise interventions that improve vascular health may be particularly beneficial for APOE4 carriers. Objectives: To test the hypothesis that exercise would more effectively increase hippocampal blood flow (HBF) in hypertensive APOE4 carriers than non carriers, we performed an analysis of arterial spin labeling MRI data (ASL MRI) from a randomized controlled trial (secondary outcome). Additionally, we tested the hypothesis that changes in systolic blood pressure (ΔSBP) would be more negatively associated with ΔHBF for APOE4 carriers than non carriers. Methods: We assigned cognitively normal adults (65 to 87 years) to a 52-week aerobic exercise intervention or education only. Genotyping was performed by Taqman SNP allelic discrimination assay. ASL MRI measured HBF before and after the 52 week intervention. We selected participants with hypertension at enrollment (n ≡ 44), defined as SBP ≥ 130mmHg or diastolic blood pressure (DBP) ≥ 80mmHg. Results: A two way ANCOVA showed a significant interaction between APOE4 carrier status and treatment group on change in HBF (ΔHBF) over the 52 weeks, controlling for age and sex (p = 0.040). For APOE4 carriers, ΔHBF was significantly (p = 0.006) higher for participants who underwent the exercise intervention (4.09 mL/100g/min) than for the control group (-2.08 mL/100g/min). There was no difference in ΔHBF between the control (-0.32 mL/100g/min) and exercise (-0.54 mL/100g/min) intervention groups for APOE4 non carriers (p = 0.918). Additionally, a multiple linear regression showed a significant interaction between ΔSBP and APOE4 carrier status on ΔHBF (p = 0.035), with a reduction in SBP associated with an increase in HBF for APOE4 carriers only. Conclusions: Aerobic exercise significantly improved HBF for hypertensive APOE4 carriers only. Additionally, only APOE4 carriers exhibited an inverse relationship between ΔSBP and ΔHBF. This suggests exercise interventions, particularly those that lower SBP, may be beneficial for individuals at highest genetic risk of AD.

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Abstract P040: The Effect Of Weight Loss And Aerobic Exercise Training On The American Heart Association’s Life’s Simple 7

Circulation ◽

10.1161/circ.143.suppl_1.p040 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Joshua E McGee ◽

Anna C Huff ◽

Marie C Clunan ◽

Nicole R Gniewek ◽

Emily E Grammer ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Weight Loss ◽

Exercise Training ◽

Aerobic Exercise ◽

Cardiovascular Health ◽

Cardiometabolic Risk ◽

American Heart ◽

Aerobic Exercise Training

There is limited evidence on the impact of weight loss via caloric restriction and aerobic exercise on Life’s Simple 7 (LS7), a health assessment tool used by the American Heart Association to promote and track cardiovascular health (CVH) via modifiable risk factors and health behaviors. Individuals with obesity have a greater prevalence of traditional and non-traditional cardiometabolic risk factors than lean individuals. Objective: Examine the effect of a weight loss intervention on LS7 and assess predictors of change in adults with obesity. Methods: Twenty-six adults (44.9 ± 9.7 years; weight: 93.9 ± 11.1 kg; body mass index: 34.1 ± 3.4 kg/m 2 ) participated in a 10-week medical weight loss program (OPTIFAST) and supervised exercise training program (50-75% VO 2 max) to achieve clinically significant weight loss (≥7% body weight). Poor, intermediate, and ideal CVH categories were defined as scores 0 to 4, 5 to 9, and 10 to 14, respectively. Baseline and post-weight loss LS7 scores were calculated via participant demographics, smoking status, anthropometry, physical activity level, diet intake, and blood lab reports. Paired samples t-test and Pearson’s correlations were used. Results: Mean weight loss was significant (-9.2 ± 3.6 kg, p < 0.001). Mean LS7 score significantly increased from baseline to weight loss (7.3 ± 1.5 vs. 9.6 ± 1.2, respectively, p < 0.001) and 57.7% of participants (15 of 26) improved to ideal CVH following weight loss. A significant inverse association was observed between change in LS7 and systolic blood pressure ( r = -0.41, p < 0.05), total cholesterol ( r = -0.45, p < 0.05), and glucose ( r = -0.41, p < 0.05). There were no further significant relationships with LS7 (i.e. change in weight, body mass index, physical activity, diastolic blood pressure). Discussion: A combined caloric restriction and aerobic exercise training intervention improved a multitude of cardiovascular disease risk factors. Previous epidemiological studies indicate meeting the ideal LS7 metrics is associated with 78% and 49% reduced risk of cardiovascular disease morbidity and mortality, respectively. Thus, the long-term modification of health behaviors and cardiometabolic risk factors to achieve ideal cardiovascular health may reduce risks of cardiovascular morbidity and mortality in individuals with obesity.

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The Effect of Exercise and Distraction on Blood Pressure Recovery Following an Anger-Provoking Stressor in Normotensive Young Adults

Journal of Psychophysiology ◽

10.1027/0269-8803/a000133 ◽

2015 ◽

Vol 29 (2) ◽

pp. 45-54 ◽

Cited By ~ 1

Author(s):

Faye S. Routledge ◽

Judith A. McFetridge-Durdle ◽

Marilyn Macdonald ◽

Lynn Breau ◽

Tavis Campbell

Keyword(s):

Blood Pressure ◽

Cardiovascular Health ◽

Exercise Intervention ◽

Recovery Period ◽

Intervention Group ◽

Exercise Group ◽

State Anger ◽

Increased Risk ◽

Anger Reactivity ◽

Quiet Sitting

Ruminating about a prior anger provoking event is found to elevate blood pressure (BP) and delay BP recovery. Delayed BP recovery may be associated with increased risk of hypertension. Interventions that improve BP recovery may be beneficial for cardiovascular health. The purposes of this study were to evaluate the influence of rumination and anger on BP reactivity and recovery, to compare the effect of an exercise intervention or distraction intervention on BP recovery and to explore if exercise improved BP recovery by distracting participants from stressor-related rumination and anger. Healthy, normotensive participants (n = 79, mean age 22.2 ± 4.0 years) underwent an anger-recall interview stressor task, 3 min of exercise (walking), distraction (reading) or no-intervention (quiet sitting) and a 15 min recovery period. State anger reactivity was associated with Δ diastolic (D) BP reactivity and approached significance with Δ systolic (S) BP reactivity. Trait rumination was associated with greater SBP during recovery. Δ SBP recovery did not differ between the exercise, distraction and no-intervention groups. Although there were no differences in Δ DBP recovery between the exercise and no-intervention groups, distraction improved Δ DBP recovery compared to the exercise intervention but not the no-intervention. The proportion of anger-related thoughts (state rumination) in the exercise group did not differ from the distraction or no-intervention groups. However, a smaller proportion of participants in the distraction intervention reported an anger-related thought during recovery compared to the no-intervention group with 76% of their thoughts relating to the provided distraction. Overall, post-stressor exercise was not found to improve BP recovery while reading was effective at distracting individuals from angry thoughts (state rumination) but had no effect on BP compared to no-intervention.

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