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Knee Osteoarthritis and Aquatic Cycling Knee osteoarthritis and aquatic cycling Citation for published version (APA): Rewald, S. (2018). Knee osteoarthritis and aquatic cycling: Development and evaluation of an exercise programme. Datawyse / Universitaire Pers Maastricht. https://doi.org/10.26481/dis.20180711sr Document status and date: Published: 01/01/2018 DOI: 10.26481/dis.20180711sr Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.umlib.nl/taverne-license Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim. Download date: 23 Sep. 2021 Knee Osteoarthritis and Aquatic Cycling Development and evaluation of an exercise programme Stefanie Rewald The research presented in this dissertation was conducted at the Care and Public Health Research Institute (CAPHRI), Department of Epidemiology, Maastricht University. CAPHRI participatesintheNetherlandsSchoolofPrimaryCareResearch(CaRe). The research described in this dissertation was funded by the Netherlands Organisation for ScientificResearch(NWO),grantnumber022.003.036. Allrightsarereserved.Nopartofthisbookmaybereproducedortransmittedinanyformorby anymeans,withoutthewrittenpermissionfromtheauthoror,whereappropriate,thepublisher ofthearticle. ©StefanieRewald,Maastricht2017 dŚĞƉŚŽƚŽŐƌĂƉŚŽŶƚŚĞĐŚĂƉƚĞƌƉĂŐĞƐƐŚŽǁƐƚŚĞĂƌƚŝŶƐƚĂůůĂƚŝŽŶ͞ĞŽŶƚƐŶĂƉƉŝŶŐ͟ĨƌŽŵƚŚĞĞůŐŝĂŶ ĂƌƚŝƐƚƌŝŬEĂŐĞůƐ͘dŚĞĂƌƚŝŶƐƚĂůůĂƚŝŽŶǁĂƐĚŝƐƉůĂLJĞĚĂƚƚŚĞďĞĂĐŚŝŶKŽƐƚĞŶĚĞŝŶƚŚĞƐƵŵŵĞƌŽĨ ϮϬϭϯ͘/ƚƐŚŽǁƐĂůĂƌŐĞŐƌŽƵƉŽĨůŝĨĞͲƐŝnjĞƐĐƵůƉƚƵƌĞƐŽĨƉƌŽĨĞƐƐŝŽŶĂůĐLJĐůŝƐƚƐƚŚĂƚǁĞƌĞĐƌĞĂƚĞĚŝŶƚŚĞ ŚŽŶŽƵƌŽĨƚŚĞϭϬϬƚŚĂŶŶŝǀĞƌƐĂƌLJŽĨƚŚĞdŽƵƌŽĨ&ůĂŶĚĞƌƐŝŶϮϬϭϯ͘&ŽƌŚŝƐĂƌƚǁŽƌŬ͕ƚŚĞĂƌƚŝƐƚǁĂƐ ŝŶƐƉŝƌĞĚďLJƚŚĞƐŵĂůů͕ďƌŝŐŚƚůLJĐŽůŽƵƌĞĚƉůĂƐƚŝĐƚŽLJĐLJĐůŝƐƚƐƚŚĂƚǁĞƌĞĂĚĚĞĚĂƐĂŐŝŵŵŝĐŬƚŽǁĂƐŚŝŶŐ ƉŽǁĚĞƌŝŶƚŚĞ^ŝdžƚŝĞƐĂŶĚ^ĞǀĞŶƚŝĞƐ͘ Layout: TinyWouters Cover: AnnikaRewald Production: Datawyse:|UniversitairePersMaastricht P UM UNIVERSITAIRE ISBN:978Ͳ94Ͳ6295Ͳ963Ͳ7 PERS MAASTRICHT KneeOsteoarthritisandAquaticCycling ĞǀĞůŽƉŵĞŶƚĂŶĚĞǀĂůƵĂƚŝŽŶŽĨĂŶ ĞdžĞƌĐŝƐĞƉƌŽŐƌĂŵŵĞ Dissertation toobtainthedegreeofDoctoratMaastrichtUniversity, ontheauthorityoftheRectorMagnificus, Prof.dr.RianneM.Letschertinaccordancewiththedecision oftheBoardofDeans,tobedefendedinpublic onWednesday11July2018,at14:00hours by StefanieRewald Supervisors Prof.dr.R.A.deBie Prof.dr.A.F.Lenssen CoͲSupervisors Dr.E.P.EMesters Dr.P.J.Emans AssessmentCommittee Prof.dr.R.J.E.M.Smeets(chair) Prof.dr.A.E.R.C.H.Boonen Prof.dr.J.Dekker(VUUniversityMedicalCenter(VUmc)Amsterdam) Dr.A.J.A.Köke Dr.P.J.vanderWees(RadboudUniversityMedicalCentre(Radboudumc) Nijmwegen) TABLEOFCONTENTS Chapter1 Generalintroduction 7 Chapter2 Aquaticcircuittrainingincludingaquaticcyclinginpatients 21 withkneeosteoarthritis:afeasibilitystudy Chapter3 Effectofaquaticcyclingonpainandphysicalfunctioning 35 comparedwithusualcareinpatientswithkneeosteoarthritis: studyprotocolofarandomisedcontrolledtrial Chapter4 Aquaticcycling–whatdoweknow? 63 AscopingreviewonheadͲoutaquaticcycling Chapter5 Efficacyofaquaticcyclingonkneepainandphysical 107 functioninginpatientswithkneeosteoarthritis: arandomisedcontrolledtrial Chapter6 Generaldiscussion 133 Summary 155 Samenvatting 161 Zusammenfassung 167 Valorisationaddendum 173 Acknowledgements 183 Abouttheauthor 191 Listofpublications 195 CHAPTER1 Generalintroduction 8 Generalintroduction This dissertation describes the development and evaluation of an aquatic cycling 1 programme for patients with knee osteoarthritis. The introduction summarises key facts about knee osteoarthritis, explains the development of aquatic cycling, and presentshypothesesofwhycyclingonastationarybikewhileimmersedinwatermight beavaluableformofaquaticexerciseforpatientswithkneeosteoarthritis. KNEEOSTEOARTHRITIS Osteoarthritis(OA)isachronicdiseasethatcanoccurinanyjointofthehumanbody. OA involves damaging and thinning of the cartilage, structural changes in the surroundingboneandosteophyteformation,ligamentouslaxity,lossofstrengthinthe periarticularmusclesandsynovialinflammation.1,2 The knees and hands are commonly affected by OA. However, OA is also known to affecthips,facetjointsandfeet.3Ͳ5Becauseoftheuniversalinvolvementofkneeand hipjointsduringtaskssuchaswalkingandstairclimbing,itisnotsurprisingthatknee andhipOAwasrankedatnumberelevenoutof291diseasescontributingtoglobal disabilityin2010.6Bothincreasingageandtheobesityepidemicareprimaryfactors contributing to the increasing prevalence of OA. By 2020, on a global scale OA is expectedtorankinthetopfiveofmostdisablingdiseases.7,8 ThelifetimeriskfordevelopingkneeOAisapproximately45%andseveralfactorsseem to cause knee OA.9 However, the development of knee OA appears to be largely influencedbytheinterplaybetweenmechanicalandsystemicriskfactors.Examplesof systematic risk factors are increasing age, obesity, female sex, physical (in)activity, ethnicity and genetics.1,3,8,10 Furthermore, individuals with a history of knee injury and/ormalalignmentofthekneeorlowerlegmuscleweakness,whichareallexamples ofmechanicalfactors,mighthaveanincreasedriskfordevelopingOA,1,3,8 The diagnosis and severity of knee OA is based on a clinical evaluation of the knee joint.11Atypicalclinicalevaluationconsistsofananamnesis(i.e.,exploringriskfactors and symptoms knee OA) and a physical examination assessing the existence of crepitus,impairedrangeofmotionandbonyenlargement.11Radiographicimagescan beusedtodetectchangesinthekneejoint.TypicalsignsofkneeOAincludenarrowing ofthejointspace,changesinsubchondralboneandformationofosteophytesatjoint margins.11TheKellgrenLawrencescore12isawidelyusedtooltoclassifyradiographic changesinkneeOAusingfivegradesrangingfromzero(nopresenceofOA)tofour (severeOA). Ingeneral,kneeOAdevelopsslowlyfromearlytolatestagescausingkneepainand disability.1Throughoutthetimecourseofthedisease,symptomsdevelopfromloadͲ dependentkneepain(e.g.afterexercise)tochronickneepainduringthedayoreven atnight.13Problemsperformingactivitiesofdailylivingmightresultinrestrictionsin 9 Chapter1 physical and social participation. These impairments can eventually affect mood and qualityofsleepandlife,whichmakeskneeOAawholepersondisease.1 (AQUATIC)EXERCISEFORPATIENTSWITHKNEE OSTEOARTHRITIS Many of the pathogenic factors and symptoms associated with knee OA may be lessenedand/orimprovedwithlifestylechanges.Forexample,regularparticipationin exerciseisamainstayinvolvedinconservativetreatment.14Therenowissubstantial evidence suggesting routine exercise can alleviate symptoms of knee OA, and has a beneficial influence on cardiovascular risk factors and comorbidities.15Ͳ17 However, exercisetrainingisunderͲutilizedinindividualswithkneeOA.18Oneofthebarriersto exercise is that performing exercise with the osteoarthritic knee appears counterintuitivetopatientsbecausethismayprovokepainfulsymptoms.19 For individuals, as OA patients, who have limited painͲtolerance for weightͲbearing activities, waterͲbased exercise is frequently recommended. The buoyancy of water lessens the effects of body weight and results in joint decompression. Evidence suggeststhataquaticexercisepositivelyaffectskneepain,physicalfunctionandquality of life in patients with OA.20 In most instances, aquatic exercise for OA patients is performed in shallow water and does not include fullͲbody under water immersion. These headͲout aquatic exercise sessions include aerobic exercise, strengthening exercise or a combination of both. Equipment can be used to increase exercise intensityandvariation.21Ͳ23Inadditiontosmallsizeaquaticequipmentsuchasbench steppingͲplatforms, other landͲbased exercise equipment such as treadmills and stationary bikes are available in waterͲproof versions. More recently, aquatic cycling hasemergedasatrendyfitnessactivity.24,25 AQUATICCYCLING AquaticcyclingisaheadͲoutaquaticexerciseactivityperformedonastationarybikein aswimmingpool.Participantsareimmersedatawaterlevelbetweennavelandchest height to ensure that the legs are immersed during the whole cycling movement withoutfloatingoffthesaddle.Inadditiontolegexercises,whichincludebothseated andoutͲofͲsaddlepositions,armandupperbodyexercisesagainstwaterresistanceare
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