The effect of dynamic versus isometric strength training on pain and functioning among adults with osteoarthritis of the knee

School of Nursing, Medical College of Georgia, Augusta, GA 30912, USA.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 10/2002; 83(9):1187-95. DOI: 10.1053/apmr.2002.33988
Source: PubMed


To compare 16 weeks of isometric versus dynamic resistance training versus a control on knee pain and functioning among patients with knee osteoarthritis (OA).
Randomized clinical trial.
Outpatient setting.
A total of 102 volunteer subjects with OA of the knee randomized to isometric (n=32) and dynamic (n=35) resistance training groups or a control (n=35).
Strength exercises for the legs, 3 times weekly for 16 weeks. Dynamic group: exercises across a functional range of motion; isometric: exercises at discrete joint angles.
The time to descend and ascend a flight of 27 stairs and to get down and up off of the floor. Knee pain was assessed immediately after each functional task. The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess perceived pain, stiffness, and functional ability.
In the isometric group, time to perform all 4 functional tasks decreased (P<.05) by 16% to 23%. In the dynamic group, time to descend and ascend stairs decreased by 13% to 17%. Both groups decreased knee pain while performing the functional tasks by 28% to 58%. Other measures of pain and functioning were significantly and favorably affected in the training groups. The improvements in the 2 training groups as a result of their respective therapies were not significantly different. The control group did not change over the duration of the study.
Dynamic or isometric resistance training improves functional ability and reduces knee joint pain of patients with knee OA.

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    • "Between group N ¼ 29 Within group N ¼ 28 Between group N ¼ 28 Within group N ¼ 28 Abbott et al., 2013 Aglamis et al., 2008 ✓ ✓ ✓ ✓ Avelar et al., 2011 ✓ # Baker et al., 2001 ✓ ✓ ⃡ ✓ Bautch et al., 1997 ✓ Bennell et al., 2005 ⃡ ✓ ⃡ ✓ Bennell et al. 2010 ✓ ✓ Brismee et al., 2007 ✓ ✓ ✓ ✓ Dias et al., 2003 ✓ ✓ Durmus et al., 2012 ✓ ✓ Ettinger et al., 1997+ ✓ ✓ Farr et al., 2010 ✓ Fitzgerald et al., 2011 ⃡ ✓ Foroughi et al., 2011 ✓ ✓ Foy et al., 2011 ✓ ✓ Hasegawa 2010 ✓ ✓ ✓ ✓ Jenkinson et al., 2009 ✓ ⃡ ✓ ✓ Kawasaki et al., 2008 ✓ ✓ Kawasaki et al. 2009 ⃡ ⃡ Keefe et al., 2004 ⃡ Kirkley et al., 2008 Lim et al., 2008 ✓ ⃡ McCarthy et al., 2004 McKnight et al., 2010 ✓ ✓ Messier et al., 2000 # ✓ Messier et al. 2007 ⃡ # Mikesky et al., 2006 ⃡ Miller et al., 2006 ✓ ✓ Ni et al., 2010 ✓ ✓ Olejerova et al., 2008 O'Reilly et al., 1999 ✓ ✓ ✓ ✓ Osteras et al., 2012 ⃡ Peloquin et al., 1999 ✓ ✓ # # Pisters et al., 2010 ✓ ✓ Rejeski et al., 2002+ # ✓ # # Rogind et al., 1998 ⃡ # ⃡ # Salancinski et al., 2012 ✓ ✓ ⃡ ⃡ Sayers et al., 2012 ⃡ ⃡ ⃡ ⃡ Schlenk et al., 2011 ⃡ ✓ Silva et al., 2008 ✓ ✓ Simao et al., 2012 # ⃡ Somers et al., 2012 ✓ # ✓ # Song et al., 2003 ✓ ✓ Talbot et al., 2003 ⃡ ⃡ ✓ Thomas et al., 2002 ✓ ✓ Topp et al., 2002 ⃡ ✓ ⃡ # Wang et al., 2009 ✓ ✓ ✓ ✓ Wang et al. 2011 ✓ Key: + ¼ findings from primary paper and follow up papers, ✓ ¼ significantly lower pain in physical activity group over time or compared to non-physical activity group/ significantly better physical function in physical activity group over time or compared to non-physical activity group. 4 ¼ no significant difference over time or between groups. "
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    ABSTRACT: To determine whether long-term physical activity is safe for older adults with knee pain. A comprehensive systematic review and narrative synthesis of existing literature was conducted using multiple electronic databases from inception until May 2013. Two reviewers independently screened, checked data extraction and carried out quality assessment. Inclusion criteria for study designs were randomised controlled trials (RCTs), prospective cohort studies or case control studies, which included adults of mean age over 45 years old with knee pain or osteoarthritis (OA), undertaking physical activity over at least three months and which measured a safety related outcome (adverse events, pain, physical functioning, structural OA imaging progression or progression to total knee replacement (TKR)). Of the 8614 unique references identified, 49 studies were included in the review, comprising 48 RCTs and one case control study. RCTs varied in quality and included an array of low impact therapeutic exercise interventions of varying cardiovascular intensity. There was no evidence of serious adverse events, increases in pain, decreases in physical function, progression of structural OA on imaging or increased TKR at group level. The case control study concluded that increasing levels of regular physical activity was associated with lower risk of progression to TKR. Long-term therapeutic exercise lasting three to thirty months is safe for most older adults with knee pain. This evidence supports current clinical guideline recommendations. However, most studies investigated selected, consenting older adults carrying out low impact therapeutic exercise which may affect result generalizability. PROSPERO 2014:CRD42014006913. Copyright © 2015. Published by Elsevier Ltd.
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    • "Within the arrays of non-pharmacological modalities used for the management of OA, there is strong evidence for the benefits of exercise in relieving pain and improving functional status in patients with knee OA.161718 A local strengthening exercise programme of the quadriceps femoris can significantly improve pain status and reduce disability level with accompanying improvement in proprioception and balance in patients with knee OA.19 Also, exercise therapy in conjunction with standardised analgesic has been advocated as a viable and effective first choice approach in the management of knee OA.20 Further, a combination of supervised range of motion strengthening exercise and supervised bicycle ergometry21 and dynamic or resistance exercise22 have been found to improve functional ability and reduce knee joint pain in patients with knee OA. "
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    • "In one study, the therapeutic effect of acupuncture was compared with placebo-acupuncture, and the mentioned study has tried to create a kind of placebo treatment by using points different from main points in acupuncture, however, it cannot be considered as a placebo for sure.[18] To evaluate the exercise in improving OA, the effect of the isometric Exercise therapeutic period by itself or along with electrical stimulation through skin, studies have been conducted, which are indicative of more improvement in most patients under exercise regime to the loose treatment.[19–22] In our study, treating with exercise, and acupuncture have had similar efficacy in improving the patient's life quality. "
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