|Year : 2015 | Volume
| Issue : 3 | Page : 162-165
Effect of walking versus resistance exercise on pain and function in older adults with knee osteoarthritis
Srishti Sanat Sharma, Megha S Sheth, Neeta J Vyas
Out-Patient Department, SBB College of Physiotherapy, VS General Hospital, Ahmedabad, Gujarat, India
|Date of Web Publication||21-Sep-2015|
Dr. Srishti Sanat Sharma
D-102 Rudra Square, Judges Bunglow Cross Roads, Bodakdev, Ahmedbad - 380 054, Gujarat
Source of Support: None, Conflict of Interest: None
Context: Knee osteoarthritis (OA) is an important cause of pain and functional limitation in older people. Several short-term studies state that walking and resistance exercise reduce pain and disability and improve physical fitness in people with knee OA. Aims: To compare the effect of walking and resistance exercise on pain and function in older adults with knee OA. Materials and Methods: A quasi-experimental study was conducted at the physiotherapy department of General Hospital. Twenty one males and females in the age range of 60-75 years, diagnosed with knee OA by the orthopedic department according to the American College of Rheumatology criteria were randomly allocated into three groups. Conventional physiotherapy treatment remained common for all the groups. Group A subjects additionally walked at a self-paced speed. Group B subjects received resistance exercise for hip and knee muscles. Group C subjects received conventional physiotherapy treatment alone. Intervention was given 5 days/week for 2 weeks. Pain intensity at rest and during activity was assessed using visual analog scale (VAS) and physical function was assessed by Western Ontario McMasters Arthritic Index (WOMAC). The level of significance was set at 5%. Results: There was a significant difference in VAS at rest within group A and group B. The difference in VAS during activity and WOMAC scores was significant within each group. Mean difference in VAS during activity revealed a significant difference between group B and group A and between group B and group C. The mean difference in WOMAC scores was significant between group A and group C. Mean difference in VAS at rest showed no difference between the groups. Conclusion: Resistance exercises are more effective in reducing pain during activity and walking is more effective in improving physical function in older adults with knee OA.
Keywords: Function, older adults, pain, resistance exercises, walking
|How to cite this article:|
Sharma SS, Sheth MS, Vyas NJ. Effect of walking versus resistance exercise on pain and function in older adults with knee osteoarthritis. Indian J Pain 2015;29:162-5
|How to cite this URL:|
Sharma SS, Sheth MS, Vyas NJ. Effect of walking versus resistance exercise on pain and function in older adults with knee osteoarthritis. Indian J Pain [serial online] 2015 [cited 2019 May 21];29:162-5. Available from: http://www.indianjpain.org/text.asp?2015/29/3/162/165839
| Introduction|| |
Osteoarthritis (OA) is the most common form of degenerative joint disease affecting 15-40% of people aged 40 years and above and 60-70% of the population older than 60 years of age.  Although most joints of the lower extremity, including the ankle and hip, may be involved the knee is the most common site for OA.  OA is a chronic degenerative disorder of multifactorial etiology characterized by loss of articular cartilage and periarticular bone remodeling, with characteristic signs such as pain during weight bearing, limitation of knee range of motion (ROM), crepitus, joint effusion, and local inflammation. , It is the most frequent joint disease with a prevalence of 22-39% in India. 
Knee OA is the most common cause of locomotor disability in the elderly.  The goal of treatment, therefore, is to alleviate pain and enhance physical function, along with preservation of joint mobility. Owing to the prevalence of knee OA in older adults and the amount of physical and psychological distress it leads them to, it is imperative to rehabilitate this population with an exercise program that is least expensive, beneficial, easy to comply with, and consumes less time and resources. Several short-term evidences suggest the role of exercises and walking in improvement of the symptoms and joint function in knee OA. In India, very few studies have examined these parameters in older adults with knee OA. Moreover, there is no general consensus on their usage and application in a clinical setup. Thus, the aim of the study was to compare the effect of walking versus resistance exercise on pain and function in older adults with knee OA.
| Materials and Methods|| |
A quasi-experimental study was conducted at the physiotherapy department of General Hospital. Twenty one males and females in the age range of 60-75 years, with knee OA diagnosed by the orthopedic department according to the American College of Rheumatology criteria,  and who were experiencing mild to moderate pain and stiffness for more than 3 months were included and randomly allocated into three groups by the envelope method. The nature and purpose of the study were explained and informed written consent was obtained from the participants in their understandable language. Individuals were excluded if they had other forms of arthritis; signs of acute inflammation, traumatic lower extremity injury, had taken corticosteroids, viscosupplement injections, sedatives, or opioids within the previous 3 months; had a history of knee infection, knee surgery or major limiting cardiovascular and neurological deficits. Intervention was given 5 days/week for 2 weeks. Pain intensity at rest and activity was assessed using the visual analog scale (VAS)  and physical function was assessed by Western Ontario McMasters Arthritic Index (WOMAC). 
Conventional physiotherapy treatment remained common for all the groups and consisted of exercises in the form of a set of 10 repetitions of quadriceps drills including ankle toe movements, static quadriceps exercise, last degree knee extension, and straight leg raise in three positions: supine, side-lying and prone, and high sitting knee extension. Stretching of the tight muscles was also performed with a 30-s hold for three repetitions. The subjects also received hot pack to the knee for 10 min. Group A subjects additionally walked at a self-paced speed on a flat surface wearing comfortable footwear, two sessions of 10 min each per day. Group B subjects received resistance exercise for the hip and knee muscles using weight cuffs, 1 session per day. All exercises were done in set of 10 repetitions. One repetition maximum (1RM) was determined. Set 1 was performed at 25% of 1RM and set 2 at 50% of 1RM. Group C subjects received conventional physiotherapy treatment alone.
The level of significance was set at 5% and data were analyzed using IBM SPSS, Version 20.0. Variables were checked for normal distribution using histogram and Kolmogorov-Smirnov test. There were 7 males and 14 females with a mean age of 63.52 ± 1.07 years. For VAS at rest and during activity, Wilcoxon signed-rank test was used for analysis within the group and one-way analysis of variance (ANOVA) was used for analysis between the groups. For WOMAC, paired t-test was used for analysis within the group and one-way ANOVA for analysis between the groups.
| Results|| |
Comparison of difference in mean VAS and WOMAC scores within groups A, B, and C are shown in [Table 1], [Table 2], [Table 3]. Differences between the groups are shown in [Table 4]. A statistically significant difference was seen within groups A and B for VAS at rest and within all the groups for VAS during activity and WOMAC (P < 0.05). Between the groups, VAS during activity and WOMAC score showed a significant difference (P < 0.05), and Bonferroni post hoc test was applied for multiple comparisons. For VAS during activity, there was a significant difference between groups A and B as well as between groups B and C. For WOMAC, groups A and C showed a significant difference. No adverse reactions to therapy were observed.
| Discussion|| |
The results of the present study showed that resistance exercises were better than walking in reducing pain during activity whereas improvement in physical function was more in the case of walking. Walking and resistance exercises were found to be equally effective in reducing pain at rest. In a systematic review, Roddy  et al. stated that both aerobic walking and home-based quadriceps strengthening exercise reduce pain and disability in knee OA. Much in line with this, the present study concluded that walking and resistance exercises were effective in reducing pain and improving physical function. Also, in the Fitness Arthritis and Seniors Trial (FAST)  study, significant improvements were noted in disability, physical performance, and pain after participating in either an aerobic or a resistance exercise program.
However, resistance exercises were more effective in reducing pain during activity as compared to walking. Several investigators have reported declines in the sensorimotor function of the quadriceps (proprioception) among knee OA patients. It has also been implicated that this decline is a primary contributor to pain and muscle weakness.  When older people with OA participate in resistance training, the training directly targets one of the main barriers to their functional performance. Hence, impairments such as muscle weakness that limit function are targeted directly. Liu  et al. stated that resistance training in older adults with knee OA improves mobility (i.e., increases gait speed), simple functional tasks (i.e., standing up from a chair), and self-rated daily function. In the present study, resistance exercises were more effective in reducing pain during activity as compared to walking. This is also supported by Lange  et al. in a systematic review, who concluded that resistance exercise is a vital component of the treatment for some of the underlying mechanisms of knee OA including muscle strength insufficiency, muscle activation imbalance, and aberrant biomechanics and cartilage loading.
Shakoon  et al. concluded that excess knee adductor moments reduced following walking comfortably in common footwear. In consistence with this, the present study showed an improvement in physical function after walking at a self-paced speed. This can be attributed to reduced excess adductor moment at the knee, improvement in muscle activation pattern, and proprioceptive loading of the knee joint. Thus, walking and resistance exercises can be incorporated, along with conventional physical therapy while treating older adults with knee OA for improvement in physical function and pain, respectively. Future studies with long-term follow-up can be undertaken. Also, activities of daily living, recreational activities, and the use of assistive devices can be considered.
| Conclusion|| |
Resistance exercises are more effective in reducing pain during activity and walking is more effective in improving physical function in older adults with knee OA.
The authors would like to thank Dr. Hemant Tiwari for his valuable insight on statistics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Corti MC, Rigon C. Epidemiology of osteoarthritis: Prevalence, risk factors and functional impact. Aging Clin Exp Res 2003; 15:359-63.
Oliveria SA, Felson DT, Reed JI, Cirillo PA, Walker AM. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 1995;38:1134-41.
Chopra A, Patil J, Bilampelly V. The Bhigwan (India). COPCORD: Methodology and first information report. APLAR J Rheumatol 1997;1:145-54.
Mundermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: Increased load at the ankle, knee, and hip walking. Arthritis Rheum 2005;52:2835-44.
Mahajan A, Verma S, Tandon V. Osteoarthritis. J Assoc Physicians India 2005;53:634-41.
Das SK, Ramakrishnan S. Osteoarthritis. In: Pispati PK, Borges NE, Nadkar MY, editors. Manual of Rheumatology. 2 nd
ed. Mumbai, India: Indian Rheumatology Association, The National Book Depot; 2002. p. 240-59.
Brotzman SB, Manske RC. The arthritic lower extremity. In: Brotzman SB, Manske RC, editors. Clinical Orthopedic Rehabilitation: An Evidence-Based Approach. 3 rd
ed. USA: Mosby; 2011. p: 380-1.
Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008;31:165-9.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15:1833-40.
Roddy A, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systemic review. Ann Rheum Dis 2005;64:544-8.
Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al
. A randomized trial comparing aerobic exercise and resistance exercise with a health educationprogram in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997;277:25-31.
Topp R, Woolley S, Hornyak J 3 rd
, Khuder S, Kahaleh B. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Arch Phys Med Rehabil 2002;83:1187-95.
Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009;CD002759.
Lange AK, Vanwanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Rheum 2008;59:1488-94.
Shakoor N, Sengupta M, Foucher KC, Wimmer MA, Fogg LF, Block JA. Effects of common footwear on joint loading in osteoarthritis of the knee. Arthritis Care Res (Hoboken) 2010;62:917-23.
[Table 1], [Table 2], [Table 3], [Table 4]