RESEARCH PROPOSAL FOR QUADRICEPS EXERCISE

1. BACKGROUND AND SIGNIFICANCE
“pain is such an uncomfortable feeling that even a tiny amount of it is enough to
ruin every enjoyment”
-WILL ROGERS
Menstruation is a normal vaginal bleeding that occurs as part of a
woman’s monthly cycle. Menopause , a natural step in the ageing process and
cessation of menstruation. The average age of menopause onset in the India is
46 years . It is a transitional stage of transfer from reproductive to post
productive era of a women’s life. Perimenopause and menopause are triggered
by follicle stimulating hormones that fluctuate and decrease the level of estrogen
and progesterone. During this age group most of the women will start to
complain about hot flushes, irritability, mood swings,headache, insomnia,
depression, urge incontinence and knee joint pain. It is a condition that every
women faces in later life and can have many associated effects which may
disrupt the quality of life.

2. Menopause is a natural physiologic process and part of the ageing process. A
women is considered in menopause when she has gone 12 months without
menstruating. Many parts of the body are affected as hormonal levels decline.
Menstrual cycle is regulated by the luteinizing hormone and follicle stimulating
hormone, decline in the level of these may cause joint pain. Estrogen helps to reduce
inflammation and as it’s level decline, inflammation may increase, causing discomfort
and menopause related knee pain.
According WHO the prevalence of menopausal symptoms was found to be
87.7%.majority of the study subjects had anxiety(80%),followed by physical and
mental exhaustion(71.5%),sleep problem(61.2%),irritability(60.7%),joint and muscular
discomfort(56%) and heart problems(54%).
A cross sectional study on women’s health information needs in menopausal age
conducted in Iran in March 2021 among 258 women aged 48 to 55 years, showed
women experiencing joint and muscle pain (62.5%), sexual problems (38%),hair and
nail problems (43%).

3. • The prevalence of menopausal symptoms and it’s effect on quality
of life among rural middle aged women (40-60 years) in march
2019 in Iran by random sampling technique. Majority of the study
subjects had anxiety (80%),physical and mental
exhaustion(71.55%),sleep problem(61.2%),joint and muscular
discomfort(56%).
• Asessment of symptoms and quality of life among post
menopausal women,A hospital based descriptive study was
conducted among 150 post menopausal women in the age group
of 55 to 59 years in march 2018 at the OPD department of Amrita
Institute of Medical Sciences. The sampling technique was simple
random sampling technique.The results was collected by face to
face interview and a questionnaire. From this study found that
prevalence level of menopausal symptoms are vaginal
dryness,decreasing sexual desire(98.45%),anxious and nervous
(81%),aching in muscles and joints(90.7%).

4. every women is unique,keeping active can help reduce body aches and tone muscles,
making the women less susceptible to injury. The menopausal women experiences aching
knees make doing household work or brisk walking difficult. Practicing quadriceps
strengthening exercises may be very helpful to reduce the pain and also helps to do daily
activities without pain and effort. According to ‘Orlando’, ’’keeping active is the key to
preventing pain and one of the main thing he says that ‘motion is lotion'. It provides a good
exchange of nutrients for the cartilage. It helps to decrease swelling and pain.
A study was conducted in to assess the effectiveness of quadriceps strengthening exercises
on knee joint pain among women in selected rural area, in 2016 Punjab. The research
design and approach was quantitative approach and quasi experimental design. The sample
size was 50 women in control group and 50 women in experimental group. The study was
conducted within 4 weeks and post test done after 3months.The result was the calculated
difference in pretest and post test score of experimental group was found highly significant.it
was inferred that there was significant relationship between joint pain among women with
educational status in control group.

5. And also during my clinical specialty posting so many women having knee joint
pain,by taken a small survey out of 10 menopausal women 7 having knee joint
pain. With this high prevalence of knee joint pain there is a need to spread
awareness about the exercises, Based on this investigator interested to do this
study.

6. PURPOSE OF THE STUDY
• The purpose of the study is to assess the menopausal
symptoms and practice of quadriceps strengthening exercises
for knee joint pain among menopausal women.

7. STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECT OF QUADRICEPS
STREGTHENING EXERCISES FOR KNEE JOINT PAIN AMONG
MENOPAUSAL WOMEN IN THE AGE GROUP OF 45-60 IN SELECTED
VILLAGES OF PATHANAMTHITTA DISTRICT”.

8. OBJECTIVES
To assess the menopausal symptoms among women at the age group of
45-60.
 Find the effectiveness of quadriceps strengthening exercises in terms of
difference in the mean pretest and post test knee joint pain scores
between experimental and control group.
Find the association between pretest scores of knee joint pain and
selected demographic variables.

9. 0PERATIONAL DEFINITIONS
1. Menopause : It is the cessation of menstruation in women in the age
group of 45-55 years. In this study women in the age group 45 to 60
years is considered.
2. Knee joint pain: It means pain in the knee joint as a result of
hormonal decline due to menopause. In this study it is measured by
WOMAC pain scale.
3. Quadriceps strengthening exercises : It means the exercises which
strengthen the quadriceps muscle. in this study it refers to practicing
quad set exercises among menopausal women to reduce knee joint
pain.

10. HYPOTHESIS
H1: There will be significant difference in pre and post test level of knee joint
pain after practice of quadriceps strengthening exercises among menopausal
women.
H1: There is significant association between knee joint pain pre test score with
selected demographic variables.

11. RESEARCH METHODOLOGY
Research approach: research approach is quantitative
research approach
Research design: The research design in the study was quasi
experimental research design.
Research variable: It include;
 Dependent variable: knee joint pain among menopausal
women.
 Independent variable: quadriceps strengthening exercises.

12. RESEARCH METHODOLOGY
 Setting of the study: The setting of the study will be selected
wards of Kaviyoor panchayat.
 Population: The population of the study includes menopausal
women at the age group of 45-60 years residing in selected wards
of kaviyoor panchayat.
 Sample size: The sample size selected for current study will be 60.
 Sampling technique: The sampling technique use in this study will
be purposive sampling techniques.

13. SAMPLING CRITERIA
A. Inclusion criteria
• Menopausal women who have knee joint pain in the age group of 45-
60 who have attained menopause more than one year.
• Women with mild and moderate knee joint pain.
• Participants who are willing to do the study.
B. Exclusion criteria
• Participants exceeding the age limit.
• Respondents not willing to do the study.
• Women having severe knee joint pain .
• Women on medicines for knee joint pain.
• Menopausal women having serious knee fracture or immobilization.

14. Tools and techniques
Tool 1: Baseline variables.
Section A : Socio demographic data which include
age,religion,educational status,occupation,type of family,family
income,support system,dietary habit.
Section B: clinical data including age at menopause,type of
menopause, duration of menopause,treatment if any.
Tool 2:Menopause rating scale.
Tool 3:WOMAC pain scale assessment tool.

15. PILOT STUDY
 Pilot study will be plan to conduct at selected ward of
kaviyoor panchayat with 10 samples, in order to check the
feasibility and practicability of the tool.

16. PLAN FOR DATA COLLECTION
• Phase 1: Before conducting study, formal permission will be obtained from the
concerned panchayat.The menopausal women in the age group of 45-60 with knee pain
will be selected by inclusion criteria. Informed consent will be obtained from the
participants.
• phase2: assessment of menopausal symptoms among women at the age group of 45-60
using menopause rating scale.
• Phase 3: Assessment of knee pain among menopausal women using WOMAC pain
score scale on experimental group. Then teach the quadriceps strengthening exercises
for the experimental group. The patients are advised to perform quadriceps
strengthening exercises in minimum 5 days with 20 minutes in a week.
• Phase 4: After 3 weeks , knee joint pain will be assessed using WOMAC pain scale for
experimental group(post test level).

17. PLAN FOR DATA ANALYSIS
• Data will be analyzed with both descriptive and inferential
statistics.
BUDGET

18. Serial no Item Amount required Income
1 Travel RS 5000
Self
2 Computer, Internet & Telephone RS 5000
3 Print & photocopies RS 6000
4 Data Analysis RS 2000
5 Postage & Courier RS 2000
6 Stationary RS 3000
7 Miscellaneous RS 2000
Total RS 25000

19. ETHICAL CONSIDERATION
 Researcher will undergo training and certificate for quadriceps strengthening
exercises from physio therapy department,TMM Hospital.
 permission will be taken from Panchayat and medical officer Phc kaviyoor.
Informed consent was taken from the samples.
 Privacy and confidentiality of the information will be maintained.
 Samples have the right to discontinue from the study if they wish to do so.

20. REFERENCES
1. Article by National library of medicine, Medline plus, health topics for menstruation.
2. WebMD, article about menopause, medically reviewed by Gabriela pilchard, MD on
june12,2022
3. www.cleveland clinic.org
4. Journal of mid-life health, Walters Kluwer-med know publications, exercises beyond
menopause.
5. En.m.wikipedia.org
6. 6. ncbi.nlm.nih.gov.
7. National library of Medicine,Harshall salve et al.Indian j public health 2010.
8. https:/www.ncbi.nlm.nih.gov>pmc.
9. Egyptian journal of health care,2022 EJHC; Vol 13, no 2.
10. Research gate, article by Mrs. Kamalijeet Kaur and Gaurav kohli, October 2020.
11. Directory of open access journals, Sweden, 2015, by Jace

21. Serial
No*
Work plan Sep oct Nov Dec Jan Feb mar April may June July Aug Sep Oct Nov Dec Jan
1 Topic
selection
X
2 Review of
Literature
X X x x x x x x x x x x
3 Topic
presentation
x
4 Draft proposal
presentation
x
5 Proposal
presentation
x
6 Ethical
committee
x
7 Synopsis
presentation
x
8 Data
collection
x
9 Data analysis x x x
10 Report writing x x x
11 Submission to
the guide and
presentation
x x x x
12 Submission to
university
x
WORK PLAN

22. INFORMED CONSENT
Dear participant,
I am Anjaly Mohan, first year MSc nursing student of TMM college of
nursing,kaviyoor.i am interested to conduct a study on the topic “ assess the
prevalence of knee joint pain and practice of quadriceps strengthening exercises
on knee joint pain in menopausal women”. I assure you that the information
given by you for the study purpose will be kept confidential. If you are interested
to be a participant in the study, please state you willingness as a participant.
Thanking you,
Yours sincerely,

23. CONSENT FORM
I ……….have voluntarily agreed to participate on the study on above mentioned title. I
understand that the information given by me will be used only for the study purpose
and will be kept strictly personal. I can contact the investigator for any further
clarification, guidance and or help
Signature of the participant.

24. DATA COLLECTION TOOL
Instruction to the participants
 Please read all the questions carefully
 The participants are requested to mark their response by putting tick mark.
 Answer all the questions.

25. Tool 1
Section A
SOCIO DEMOGRAPHIC DATA
1.Age in years?
2.Educational status
a. High school.
b.Higher secondary
c. graduate
d. post graduate

26. 3. Occupation
a. Unemployed/house wives
b. Self employed/business
c. Private employee
d. Government employee/retired.
4. Type of family
a. Nuclear family
b. Joint family
c. Extended family
5. Which Social support do you have?
a. Familial support
b. Partner support
c. Both
d. No source of support

27. 6. Family income
a. <5000
b. 5001 to 10000
c.>10000.
7. Religion
a.Hindu
b.Christian
c.Muslim
d.others
8. Dietary habits
a. vegetarian
b.non-vegetarian

28. SECTION B
Gynecological data
10. Age at menopause?
11. Type of menopause
a. natural
b. surgical
c. hormonal
12. Duration of menopause
a. More than one year
b. 2-3 years
c. more than 3 years.
13.Are you taking any medicines? If yes specify…
TOOL 2

30. Serial
no
Questions None Mild Moderate Severe Extreme Score
How much pain do you have?
1 In walking on
flat surface
2 Going up or
downstairs
3 At night, while
in bed
4 Sitting or lying
5 Standing
upright
How much is your stiffness?
6 After first
wakening in the
morning
7 After sitting ,
lying or resting
later in the day
How much difficulty do you have
8 Descending
stairs
9 Ascending
TOOL 3
WOMAC PAIN SCALE USED FOR ASESSING KNEE PAIN.
Options are;
•Samples are requested to put a tick mark over the response.

31. The test questions are scored on a scale on 0-4, which correspond to none (0), mild
(1), moderate (2), severe (3), extreme (4). The scores for each subscale are
summed up with a possible score range of 0-20 for pain, 0-8 for stiffness, 0-68 for
physical function. Sum of the scores for all three subscales gives a total WOMAC
score. Higher score on the WOMAC indicate worse pain, stiffness and functional
limitations.
QUADRICEPS STREGTHENING EXERCISES
What are quadriceps strengthening exercises?
The quadriceps (or quads) are the four muscles located on the anterior of the thigh. They pull
together to help flex the hip and extend (or straighten) the knee. It consists of four individual
muscles rectus femoral, vastus lateralis, vastus medialis, and vastus intermedius. These muscles
form the bulk of the thigh.
The quadriceps often become weak after an injury or surgery on the lower leg or thigh or
associated with problems of menopause, so they have to strengthen the quadriceps. The person
with certain conditions mostly has weakness in the quadriceps. These conditions include: Patello
femoral stress syndrome, Ilio tibial band friction syndrome, Patellar tendonitis or tendinosis.

32. This simple exercises that you can do at your home to strengthen the quadriceps
muscles.
Health benefits by doing a quadriceps strengthening exercise.
 Regularly doing quadriceps strengthening exercises may help to make it easier
to extend your knee and flex your hip.
 Helps to strengthen your quadriceps muscles.
 Helps to improve the stability of your kneecap.
 Helps to protect your knee joint from injury.
 Helps to increase your jump height.
 Helps to improve your overall athletic ability.
 Helps to decrease your risk of developing knee osteoarthritis.
 Helps to improve your balance and stability.
 Stronger quadriceps make everyday movements easy such as walking,
bending, and sitting, running.

33. How do I perform quadriceps strengthening exercises
safely?
Always stretch before you do strengthening exercises.
As you get stronger, your healthcare provider may tell
you to you add weights or more repetitions to your
strengthening exercises. He or she will tell you how
much weight to use.
8.Quad set exercise: Lie on a flat, firm surface. Bend
your left leg until your foot is flat on the floor. Keep your
right leg straight. Tighten the top of your right thigh and
hold for 10 to 20 seconds, and then relax. Repeat this
exercise 5 to 10 times and then repeat on your other leg.

34. 10.Sitting leg lifts: Sit in a chair. Slowly straighten and
raise one leg. Squeeze your thigh muscles and hold for 5
seconds. Relax and return your foot to the floor. Do 2
sets of 10 lifts on each leg.

35. 11.Standing half squats: Stand with your feet shoulder-
width apart. Lean your back against a wall or hold the
back of a chair for balance, if needed. Slowly sit down
about 10 inches, as if you are going to sit in a chair. Your
body weight should be mostly over your heels. Hold the
squat for 5 seconds, then rise to a standing position.
Repeat 10 times for 1 set. Rest for 1 to 2 minutes. Do
another set of 10.

36. Step ups: Use a 6-inch stool, step, or other platform to do
this exercise. Place one foot on top of the platform. Lift
your other foot off the floor and let it hang loosely. Stay in
that position for 3 to 5 seconds. Then, slowly lower your
foot to the floor. Lower your other foot off the platform
surface and onto the floor. Repeat this exercise 5 to 10
times and then repeat on your other leg.

37. A study to assess the prevalence of menopausal symptoms and it’s effect
on quality of life among rural middle aged women (40-60 years)of
Haryana,india.A community based cross sectional study was conducted in
400 middle aged women from april 2018 to march 2019 by random
sampling technique. Majority of the study subjects had anxiety
(80%),physical and mentalexhaustion(71.55%),sleep problem(61.2%),joint
and muscular discomfort(56%).Another study was prevalence and severity
of menopausal symptoms and the quality of life in middle aged women ;a
study from Sri Lanka,the descriptive cross sectional study was included
184 pre menopausal and post menopausal women aged 30to 60 years,the
study was 2015 to 2017 by using cluster sampling method.
The result was women experiencing symptoms like mental and physical
exhaustion(49.5%),joint and muscular discomfort (48.5%) and
irritability(41.3%).

38. A cross sectional study was done in kottayam,which was conducted
among 400 women residing in a rural area aged 40 to 60 years in may
2015.of south kerala by house to house survey using semi structured
questionnaire.The results was among the women surveyed 79.9% had at
least one symptom out of the 23 symptoms studied.the most frequent
symptom was joint pain35.8%and lethargy32.3%. Asessment of
symptoms and quality of life among post menopausal women in tertiary
care hospital in kochi,A hospital based descriptive study was conducted
among 150 post menopause women in the age group of 55 to 59 years in
march 30 2018 at the OPD department of Amrita Institute of Medical
Sciences. The sampling technique was simple random sampling
technique.The results was collected by face to face interview and a
questionnaire.from this study found that prevalence level of menopausal
symptoms are vaginal dryness,decreasing sexual desire(98.45%),anxious
and nervous (81%),aching in muscles and joints(90.7%).

39. A study was conducted in to assess the effectiveness of quadriceps
strengthening exercises on knee joint pain among women in selected rural
area, in 2016 Punjab. The research design and approach was quantitative
research approach and quasi experimental design. The sample size was 50
women in control group and 50 women in experimental group. The study
was conducted within 4 weeks and post test done after 3months.The result
was the calculated difference in pretest and post test score of experimental
group was found highly significant.it was inferred that there was significant
relationship between joint pain among women with educational status in
control group.
According to WHO,It is estimated that approximately 3.8% of the world’s
population that is approximately 277 million people worldwide can’t run or
can’t walk with ease. This is because of a progressive, painful and
inflammatory condition of the knee joint. But mostly is found to affect people
in early middle age and thereafter. It can seriously affect quality of one’s life.
About 25% of people over the age of 50 experiences knee pain from
degenerative diseses.5 Knee joint pain is highly prevalent in those above the
age of 60 years.

40. .A cross sectional study was conducted in a rural area of New Delhi among
252 post menopausal women from October 2011 to march 2013.a
pretested,self designed ,semi structured questionnaire was used.The
results was mean age at attaining menopause was 46.24years.A total of
225 post menopausal women experienced atleast one or more
menopausal symptoms.The most common complaints of post menopausal
women were sleep disturbances(62.7%), muscle or joint pain(59.1%),hot
flushes(46.4%) etc.And also during my clinical specialty posting so many
women having knee joint pain,by taken a small survey out of 10
menopausal women 7 having knee joint pain. With this high prevalence of
knee joint pain there is a need to spread awareness about the exercises,
Based on this investigator interested to do this study.

41. A study was conducted in to assess the effectiveness of quadriceps strengthening exercises on knee
joint pain among women in selected rural area, in 2016 Punjab. The research design and approach
was quantitative approach and quasi experimental design. The sample size was 50 women in control
group and 50 women in experimental group. The study was conducted within 4 weeks and posttest
done after 3months.The result was the calculated difference in pretest and post test score of
experimental group was found highly significant.it was inferred that there was significant relationship
between joint pains among women with educational status in control group.