Prof Pazit Levinger

Recipient: Prof Pazit Levinger
Intended department: Institute of Sport, Exercise & Active Living (ISEAL)- Victoria University- funded by Eventide Homes & Arthritis Australia


High speed resistance training and balance training for people with knee osteoarthritis: a pilot randomised controlled trial


Falls are among the most common cause of injury and hospital admissions in older people in Australia. The number of falls experienced by people who have knee osteoarthritis is almost double the number experienced by people who have no osteoarthritis in their joints. In our previous research work, we found that when simulating a forward fall those with knee osteoarthritis demonstrated slower step responses and impaired ability by the knee joint to absorb impact forces and slow down the body forward momentum to arrest a fall. The inability of the muscle to respond quickly might be related to loss of muscle power (the ability to produce force rapidly), especially in the quadriceps, which are the most commonly affected muscles in those who suffer from knee osteoarthritis. Therefore training the ability to generate force quickly specific to daily living tasks might help to maintain muscle function and effective stepping responses, which also has the potential to prevent falls. Exercise interventions that focus on balance exercises have been shown to be effective in reducing falls for older people. However, there is no evidence to suggest that using current fall prevention programs will be also effective for people with knee OA. Moreover, existing exercise-based fall prevention programs mainly focus on maintenance of balance and do not focus on training the  ability of the muscle to produce force rapidly (known as muscle power), which is required to arrest a  fall when losing balance.  The questions that were aimed to be answered by the grant: In this study we examined the feasibility and safety of eight weeks high speed resistance training
programs with and without balance exercises for people with knee osteoarthritis. The effect of the exercise programs on strength, balance, physical function, pain and executive function was also examined. The results of this study aimed to assist us to understand what type of exercise is safe and beneficial for people with knee osteoarthritis to reduce their risk of falling and hence to inform the development of a future large research trial.  To address the research questions three groups were involved and compared in the study: a control group (received no intervention), a high speed resistance training program and a high speed resistance training plus balance exercises program. Participants from all groups were examined at
the beginning and after 8 weeks. The pain level during and after each exercise sessions was recorded. Attendance was also recorded as well as any drop out due to reasons associated with the exercise program. Comparison between the groups also took place to determine any improvements in strength, function, balance and mobility.

Twenty-eight participants, average age 67.8 years, took part in the study. Our results demonstrated that the high speed resistance trainings with and without balance exercises were safe and feasible interventions for people with knee osteoarthritis. We reported no drop-outs associated with the exercise programs or adverse events. Both exercise programs resulted in high adherence, satisfaction and overall pain reduction during and after the exercise sessions throughout the eight week exercise program. Both groups also showed improvement in function and lower limb strength. The study incorporated weight bearing   functional exercises (e.g., sit to stand, squat) in addition to dynamic and static balance exercises (in the combined group), which resulted in improved muscle performance measures as well as functional power task. Consequently, the combination of the high speed functional movements and the balance exercises might provide beneficial effect on muscle coordination and integration that are more likely to translate into daily activities. Given the pain associated with knee osteoarthritis, it was important to monitor pain during and after exercise sessions to determine the effect of the rapid and powerful movements had on knee pain. Throughout the exercise programs, there were several instances of substantial pain during or after the exercise program. in most instances, the pain subsided within 24 hours. Mild to moderate pain is expected in some people with knee osteoarthritis while exercising, and provided it is short term and
returns to baseline relatively quickly, should not be perceived as damaging.

The next research direction should examine the optimal combination of high speed resistance and balance exercises and its effect on the actual number of falls in people with knee osteoarthritis.