High intensity aquatic resistance training over 4 months led to decreases in body fat and improvements in walking speed in post-menopausal women with mild knee osteoarthritis. Only the improvements in walking speed were maintained at the 12-month follow-up. Leisure time physical activity had a small relationship with changes in body fat and walking speed. The aquatic training was well-tolerated with some initial joint pain that decreased over the 4 months and no participants dropped out due to dyspnea.

1. Effects of high intensity resistance
aquatic training on body composition
and walking speed in women with mild
knee osteoarthritis: a 4-month RCT with
12-month follow-up
學生：曾怡珊
指導教授：曹昭懿老師
18/11/21

2. 2
2017

3. 3PEDro score: 6/10

4. 4

5. 5
2016
2013
Data collection:
Jan. 2012-Apr. 2014

6. Background-1
1. Recently focus has shifted from treatment of
end-stage OA to preventing progression of the
disease, especially in early knee OA2.
2. Risk factors predicting worsening in symptoms
and activity limitations include slow walking
speed, obesity, older age and decreased
leisure time physical activity (LTPA)3,4
3. Obesity is associated with knee OA progression
through sub-optimal biomechanical loading
and low grade systematic inflammation related
to high body fat mass.2,5
6

7. Background-2
7
Aquatic
exercises
benefits
Reduced weight
bearing and
impact force 12
Less pain as
the same
intensity as
land group13,14
Small and
moderate effect
on physical
functioning15
https://tinyurl.com/y7dwohq4
Ａ Ｂ Ｃ

8. Background-3
O The aims of this study are to report the effects of
4-months intensive aquatic resistance training
program on body composition and functional
capacity in post-menopausal women with mild
knee OA, and whether possible changes are
maintained after 12-months’ follow-up.
O The effect of LTPA on the results and the training
intensities achieved during the aquatic
resistance training will also be investigated.
8

9. Materials and methods
1) Study design
2) Subject recruitment
3) Randomization and blinding
4) Interventions
5) Measures of exercise intensity
6) Outcome measures
7) Leisure Time Physical Activities (LTPA)
8) Statistical Methods
9

10. Materials and methods-1
1) Study design
a. A RCT consisting a 4-month aquatic intervention with a
12-month follow-up period
b. Two experimental arms
u Aquatic resistance training (AT: 48 Aquatic PT sessions)
u Control (Con: 2 PT sessions )
c. Included participants (Fig.1)
d. Outcomes: Body composition, walking speed, self-
reported symptoms and LTPA
e. Pre- and post-intervention, 12-months follow-up
10

11. Materials and methods-2
11
O The study design and reporting follows the
CONSORT recommendations for the
conducting and reporting of randomized
controlled trial21.
O The study protocol (Dnro 19U/2011) was
approved by the Ethics Committee of the
Central Finland Health Care District and
conforms to the Declaration of Helsinki.
O Written informed consent was obtained from
all participants prior to enrolment.

12. 12Fig.1
60-68 yr. Post-menopausal
women, BMI34, knee pain
almost daily (VAS5/10), )K/L
grades 1-2 , no other medical
reason preventing full participation
https://tinyurl.com/y8wo7oq2

13. 13
Attendance: 88% Attendance: 68%
Stratified according to K/L grade (blocked randomization of size of 10)
n=84
n=76
Intention-to-treat

14. 14
Calf raise,
Balance,
Abdominals,
Jumping,
Dynamic balance
Walking,
Cycling,
Stretching
1 hour/session, 3 sessions/ week, 48 sessions, 6-8 participants/
group, water temperature: 32 degree c, water depth: 13.-1.5 m

15. 15

16. 16

17. Results
1. Training intensities achieved during aquatic resistance
training (Table 2)
2. Treatment effects and maintenance at 12-months (Table
3)
3. Effects of physical activity (LTPA)
Mixed-effects regression model (Cohen’s f2)
a) Fat mass —small relation (f2=0.05) (p=0.007)
b) Lean mass—no relation (f2=0.002) (p=0.52)
c) Walking speed—small relation (f2=0.02) (p=0.25)
4. Harms
a) Pain (37 times/1st month à reduced to 12 times/4th
month), 1 drop-out
b) Dyspnoea (completed the intervention and attend follow-
up measurements)
17

18. 18
A bootstrap type t-test
No
significant
difference

19. 19
Repeated analysis of
variance (ANOVA),
Statistical software (Stata,
release 13.1, StataCorp,
College Station, Texas)
Self-reported emotional state: 1-poor, 2-tolerable, 3-satisfactory, 4-good, 5-excellent
Frontal area: 0.0181 m2 ,0.075 m2
Polar heart rate monitors (F6 or RCX5, Polar Oy, Finland)

20. 20
Generalized linear mixed-models with
unstructured correlation structure
Body composition : DXA (Lunar Prodigy; GE Lunar Healthcare, Madison, WI, USA).
Walking speed : the UKK 2 km walking test (around a 200 m flat track as quickly as possible without
running)
LTPA: a daily physical activity diary, recorded type of activity and self- perceived intensity of each activity, i.e.,
low, moderate or high, from which metabolic equivalent task hours (MET/h) per month was calculated

21. 21
P=0.002
P=0.002
P=0.032

22. Body composition changes
after 4 month intervention
22
Body mass
(p=0.004)
β=0.34 (0.15-0.52)
AT, Con: -1.4%, +0.21%
Fat mass: Total body
(p=0.002)
β=0.32 (0.14-0.51)
AT, Con: -4.7%, +0.25%
Fat mass: Lower extremities
(p0.001)
AT, Con: -4.5%, +1.1%
(AT: -0.47kg, -0.74~-0.20)
Fat mass: Trunk
(p=0.007)
AT, Con: -4.7%, +0.25%
(AT: -0.63kg, -1.1~-0.17)
β: (Effect size)
0.1-small, 0.3-moderate, 0.5-large

23. 23
P0.001
P=0.56
LTPA

24. Results
1. Training intensities achieved during aquatic resistance
training : RPE, repetitions per session
2. Treatment effects and maintenance at 12-months: Body
mass, BMI, Fat mass, LTPA, walking speed
3. Effects of physical activity (LTPA)
Relationship: Mixed-effects regression model (Cohen’s f2)
a) Fat mass —small relation (f2=0.05) (p=0.007)
b) Lean mass—no relation (f2=0.002) (p=0.52)
c) Walking speed—small relation (f2=0.02) (p=0.25)
4. Harms
a) Pain (37 times/1st month à reduced to 12 times/4th
month), 1 drop-out
b) Dyspnoea (completed the intervention and attend follow-
up measurements)
24

25. Discussion
25

26. Conclusion
O A relatively short high intensity aquatic resistance
training program decreases fat mass and improves
walking speed in post-menopausal women with
mild knee OA. Only improvements in walking speed
were maintained at 12-months follow-up.
O LTPA appeared more important for controlling body
composition than walking speed.
O Future research should investigate if lifestyle
education following an intensive aquatic resistance
training intervention optimizes long term benefits
for people with knee OA.
O Additionally, research is needed to discover through
which mechanism aquatic resistance training
improves walking speed. 26

27. Take home messages
27

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30. Thank you for your time
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