Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement.

OBJECTIVE To study the effects of aquatic resistance training on mobility, muscle power, and cross-sectional area. DESIGN Randomized controlled trial. SETTING Research laboratory and hospital rehabilitation pool. PARTICIPANTS Population-based sample (N=50) of eligible women and men 55 to 75 years old 4 to 18 months after unilateral knee replacement with no contraindications who were willing to participate in the trial. INTERVENTIONS Twelve-week progressive aquatic resistance training (n=26) or no intervention (n=24). MAIN OUTCOME MEASURES Mobility limitation assessed by walking speed and stair ascending time, and self-reported physical functional difficulty, pain, and stiffness assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee extensor power and knee flexor power assessed isokinetically, and thigh muscle cross-sectional area (CSA) by computed tomography. RESULTS Compared with the change in the control group, habitual walking speed increased by 9% (P=.005) and stair ascending time decreased by 15% (P=.006) in the aquatic training group. There was no significant difference between the groups in the WOMAC scores. The training increased knee extensor power by 32% (P<.001) in the operated and 10% (P=.001) in the nonoperated leg, and knee flexor power by 48% (P=.003) in the operated and 8% (P=.002) in the nonoperated leg compared with controls. The mean increase in thigh muscle CSA of the operated leg was 3% (P=.018) and that of the nonoperated leg 2% (P=.019) after training compared with controls. CONCLUSIONS Progressive aquatic resistance training had favorable effects on mobility limitation by increasing walking speed and decreasing stair ascending time. In addition, training increased lower limb muscle power and muscle CSA. Resistance training in water is a feasible mode of rehabilitation that has wide-ranging positive effects on patients after knee replacement surgery.

[1]  L. Woodhouse,et al.  Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. , 1998, Physical therapy.

[2]  Hakan Gür,et al.  Muscle mass, isokinetic torque, and functional capacity in women with osteoarthritis of the knee. , 2003, Archives of physical medicine and rehabilitation.

[3]  M. Dewey,et al.  Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials , 2007, BMJ : British Medical Journal.

[4]  Mauricio Silva,et al.  Knee strength after total knee arthroplasty. , 2003, The Journal of arthroplasty.

[5]  L. Brown,et al.  Knee Extensor and Flexor Torque Characteristics Before and After Unilateral Total Knee Arthroplasty , 2006, American journal of physical medicine & rehabilitation.

[6]  R. Hinman,et al.  Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial , 2007, Physical Therapy.

[7]  S. Kellis,et al.  THE EFFECTS OF A TWENTY‐FOUR‐‐WEEK AQUATIC TRAINING PROGRAM ON MUSCULAR STRENGTH PERFORMANCE IN HEALTHY ELDERLY WOMEN , 2006, Journal of strength and conditioning research.

[8]  J Avela,et al.  Leg extension power and walking speed in very old people living independently. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[9]  Jack Crosbie,et al.  Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. , 2009, Arthritis and rheumatism.

[10]  J. G. Evans,et al.  Oxford textbook of geriatric medicine , 2000 .

[11]  L. Woodhouse,et al.  Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability. , 1998, The Journal of orthopaedic and sports physical therapy.

[12]  M. Crotty,et al.  Does hydrotherapy improve strength and physical function in patients with osteoarthritis—a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme , 2003, Annals of the rheumatic diseases.

[13]  Nih Consensus Panel.  NIH Consensus Statement on total knee replacement December 8-10, 2003. , 2004 .

[14]  Mati Pääsuke,et al.  Quadriceps femoris muscle voluntary isometric force production and relaxation characteristics before and 6 months after unilateral total knee arthroplasty in women , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[15]  M. Kjaer,et al.  Muscle size, neuromuscular activation, and rapid force characteristics in elderly men and women: effects of unilateral long-term disuse due to hip-osteoarthritis. , 2007, Journal of applied physiology.

[16]  T. Rantanen,et al.  Leg Extension Power Deficit and Mobility Limitation in Women Recovering from Hip Fracture , 2008, American journal of physical medicine & rehabilitation.

[17]  Cheng-Kung Cheng,et al.  Muscle Strength After Successful Total Knee Replacement: A 6- to 13-Year Followup , 1996, Clinical orthopaedics and related research.

[18]  D C Voaklander,et al.  Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. , 2000, The Journal of rheumatology.

[19]  H. Bliddal,et al.  A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. , 2008, Journal of rehabilitation medicine.

[20]  Per Aagaard,et al.  Resistance training induces qualitative changes in muscle morphology, muscle architecture, and muscle function in elderly postoperative patients. , 2008, Journal of applied physiology.

[21]  M. Conditt,et al.  Does Total Knee Replacement Restore Normal Knee Function? , 2005, Clinical orthopaedics and related research.

[22]  P. Era,et al.  Effects of strength and endurance training on isometric muscle strength and walking speed in elderly women. , 1996, Acta physiologica Scandinavica.

[23]  K. Keskinen,et al.  Neuromuscular function during therapeutic knee exercise under water and on dry land. , 2001, Archives of physical medicine and rehabilitation.

[24]  J. M. Quintana,et al.  Effect of patient characteristics on reported outcomes after total knee replacement. , 2007, Rheumatology.

[25]  K. Garvin,et al.  Preoperative physical therapy in primary total knee arthroplasty. , 1998, The Journal of arthroplasty.

[26]  L. Goldman,et al.  Patient quality of life during the 12 months following joint replacement surgery. , 2004, Arthritis and rheumatism.

[27]  T. Thornhill,et al.  Current concepts of total knee arthroplasty. , 1998, The Journal of orthopaedic and sports physical therapy.

[28]  Hélène Moffet,et al.  Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial. , 2004, Archives of physical medicine and rehabilitation.

[29]  David E Krebs,et al.  Update on hip and knee arthroplasty: current state of evidence. , 2005, Arthritis and rheumatism.

[30]  K. Keskinen,et al.  Effects of aquatic resistance training on neuromuscular performance in healthy women. , 2002, Medicine and science in sports and exercise.

[31]  Dan K Ramsey,et al.  Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. , 2008, Clinical biomechanics.

[32]  W. Brechue,et al.  Water-based exercise improves health-related aspects of fitness in older women. , 2002, Medicine and science in sports and exercise.

[33]  L. Snyder-Mackler,et al.  Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[34]  L. Snyder-Mackler,et al.  Quadriceps strength and the time course of functional recovery after total knee arthroplasty. , 2005, The Journal of orthopaedic and sports physical therapy.

[35]  G. Borg.  Borg's Perceived Exertion and Pain Scales , 1998 .

[36]  C. Goldsmith,et al.  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. , 1988, The Journal of rheumatology.

[37]  C. Brot,et al.  Early changes in muscle strength after total knee arthroplasty. A 6-month follow-up of 30 knees. , 1999, Acta orthopaedica Scandinavica.

[38]  H. Suominen,et al.  Effects of strength and endurance training on muscle fibre characteristics in elderly women. , 1997, Clinical physiology.

[39]  J. Whitney,et al.  Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. , 2007, Journal of advanced nursing.

[40]  Sandra G Brauer,et al.  A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. , 2009, Archives of physical medicine and rehabilitation.

[41]  H. Suominen,et al.  Effects of strength and endurance training on thigh and leg muscle mass and composition in elderly women. , 1995, Journal of applied physiology.

[42]  Ari Heinonen,et al.  Muscle Deficits Persist After Unilateral Knee Replacement and Have Implications for Rehabilitation , 2009, Physical Therapy.

[43]  S. Hasson,et al.  Lower-limb force production in individuals after unilateral total knee arthroplasty. , 2004, Archives of physical medicine and rehabilitation.

[44]  J. Petrella,et al.  Contributions of force and velocity to improved power with progressive resistance training in young and older adults , 2007, European Journal of Applied Physiology.

[45]  S. Lamb,et al.  Recovery of mobility after knee arthroplasty: expected rates and influencing factors. , 2003, The Journal of arthroplasty.