Asymmetrical muscle strength deficit, mobility limitation and aquatic resistance training in persons

116 Pages·2013·1.38 MB·English

by  Anu Valtonen

STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH
191
Anu VJaelntonni eKnulmala
Asymmetrical Muscle Strength
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Aquatic Resistance Training in
Persons With Knee Osteoarthritis
STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH 191
Anu Valtonen
Asymmetrical Muscle Strength Deficit,
Mobility Limitation and Aquatic
Resistance Training in Persons With
Knee Osteoarthritis
Esitetään Jyväskylän yliopiston liikuntatieteellisen tiedekunnan suostumuksella
julkisesti tarkastettavaksi Historica-rakennuksen salissa H320
maaliskuun 16. päivänä 2013 kello 12.
Academic dissertation to be publicly discussed, by permission of
the Faculty of Sport and Health Sciences of the University of Jyväskylä,
in building Historica, hall H320, on march 16, 2013 at 12 o’clock noon.
UNIVERSITY OF JYVÄSKYLÄ
JYVÄSKYLÄ 2013
Asymmetrical Muscle Strength Deficit,
Mobility Limitation and Aquatic
Resistance Training in Persons With
Knee Osteoarthritis
STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH 191
Anu Valtonen
Asymmetrical Muscle Strength Deficit,
Mobility Limitation and Aquatic
Resistance Training in Persons With
Knee Osteoarthritis
UNIVERSITY OF JYVÄSKYLÄ
JYVÄSKYLÄ 2013
Editors
Ina Tarkka
Department of Health Sciences, University of Jyväskylä
Pekka Olsbo, Ville Korkiakangas
Publishing Unit, University Library of Jyväskylä
URN:ISBN:978-951-39-5090-3
ISBN 978-951-39-5090-3 (PDF)
ISBN 978-951-39-5089-7 (nid.)
ISSN 0356-1070
Copyright © 2013, by University of Jyväskylä
Jyväskylä University Printing House, Jyväskylä 2013
ABSTRACT
Valtonen, Anu
Asymmetrical muscle strength deficit, mobility limitation and aquatic resistance
training in persons with knee osteoarthritis
Jyväskylä: University of Jyväskylä, 2013, 87 p.
(Studies in Sport, Physical Education and Health
ISSN 0356-1070; 191)
ISBN 978-951-39-5089-7 (nid.)
ISBN 978-951-39-5090-3 (PDF)
Finnish summary
Diss.

The purpose of the study was to investigate the asymmetrical muscle deficit of
the lower limbs, and its consequences for mobility limitation in 50-75-year-old
persons with knee osteoarthritis (OA) and knee replacement. Also, the effects of
aquatic resistance training on mobility limitation, muscle power, torque, cross-
sectional area (CSA), and asymmetrical muscle deficit, and the maintenance of
training-induced benefits were studied in persons with knee replacement.
Data from two research projects were used. KNEE-OA is a clinical
randomized controlled trial (n=43) on the rehabilitation of patients suffering
from end-stage OA of the knee joint. KNEE-REPLACEMENT is a clinical
randomized controlled trial (n=50) on the effects of aquatic resistance training
including patients recovering from knee replacement. Mobility limitation,
muscle power, torque and muscle CSA were assessed, and the asymmetrical
muscle deficit was calculated. Persons with knee replacement participated in 3-
month aquatic resistance training intervention that aimed to improve lower
limb muscle power and torque, and thus mobility. The maintenance of training-
induced benefits was examined 12 months after cessation of training.
Persons with knee OA and knee replacement had substantial asymmetrical
deficit in knee extensor and flexor power, torque and thigh CSA, from which
asymmetrical muscle power deficit was associated with stair ascension.
Progressive aquatic resistance training was feasible and effective for persons with
knee replacement. Training decreased mobility limitation and asymmetrical
muscle deficit. In addition, muscle power, torque and CSA increased by training.
Training-induced benefits in muscle power were maintained at follow-up.
The results of the study indicate that large asymmetrical muscle deficits in
lower limbs are present in persons with knee OA and knee replacement, and
have effects on mobility limitation as well. In addition, aquatic resistance
training offers an effective means to decrease mobility limitation by increasing
muscle power, torque, muscle CSA and decreasing asymmetrical muscle deficit
of the lower limbs. The results also suggest that training-induced benefits in
muscle power may be maintained with regular physical activity alone.

Keywords: osteoarthritis, knee replacement, mobility limitation, asymmetrical
muscle deficit, aquatic resistance training.
Author’s address Anu Valtonen, MSc
Department of Health Sciences
University of Jyväskylä
P.O. Box 35
FI-40014 University of Jyväskylä, Finland

Rehabilitation and Pain Unit
Kymenlaakso Central Hospital
Kotkantie 41
FI-48210 Kotka, Finland

[email protected]

Supervisors Professor Ari Heinonen, PhD
Department of Health Sciences
University of Jyväskylä
Jyväskylä, Finland

Professor Sarianna Sipilä, PhD
Gerontology Research Center and Department of Health
Sciences
University of Jyväskylä
Jyväskylä, Finland

Exercise Physiologist Tapani Pöyhönen, PhD
Rehabilitation and Pain Unit
Kymenlaakso Central Hospital
Kotka, Finland

Reviewers Associate Professor Rana Hinman, PhD
Physiotherapy Department
University of Melbourne
Melbourne, Australia

Researcher Helena Gapeyeva, MD, PhD
Institute of Exercise Biology and Physiotherapy
University of Tartu
Tartu, Estonia

Opponent Adjunct Professor Jari Arokoski, MD, PhD
Institute of Clinical Medicine
University of Eastern Finland
Kuopio, Finland
ACKNOWLEDGEMENTS
The present study was carried out in the Rehabilitation and Pain Unit,
Kymenlaakso Central Hospital together with the Department of Health Sciences,
University of Jyväskylä. Both of them provided me with the possibility to work
with many wonderful and skillful people, who all have, in part, influenced this
study. Thank you all.
I had the privilege to complete this thesis under supervision of Professor
Ari Heinonen PhD from the Department of Health Sciences, Professor Sarianna
Sipilä PhD from the Gerontology Research Center and Department of Health
Sciences, and Exercise Physiologist Tapani Pöyhönen PhD from the
Kymenlaakso Central Hospital. I thank all of you for making the completion of
this process possible, even though the supervision was challenging as it was
conducted mostly via telephone or email. Ari, you always had time to comment
on my work. If your day was full then we would still have a meeting between
Jyväskylä and Tampere in the animal carriage of the train. Sarianna, you gave
me skillful and very fast advice whenever needed. You also found time for my
work in the middle of your busy schedule: once we had a meeting at the main
railway station in Helsinki between the alcoholics. Tapsa, my deepest gratitude
concerning this thesis goes to you. You made all this possible, sometimes even
at your own expense. After my Master of Science studies you organized me a
job, dragged me into my very first congress and introduced me to the scientific
world. Also, during this lengthy process, my almost daily and very long but
encouraging telephone conversations with you have been really helpful. Thank
you.
My sincere gratitude goes to the official reviewers of this thesis, Associate
Professor Rana Hinman PhD and Researcher Helena Gapeyeva MD, PhD for
your valuable comments of this thesis. I also want warmly thank Adjunct
Professor Jari Arokoski MD, PhD for agreeing to be the opponent in the public
defense of this dissertation.
I would like to express my gratitude to Chief Physician Jukka Savolainen
MD, PhD from the Kymenlaakso Central Hospital. You provided the facilities
for this work, helped with financing of the project and also provided inspiring
discussions throughout the process. Thank you. I want to warmly acknowledge
Mikko Manninen MD, PhD for collecting the participants and helping me move
forward. Thanks to the rehabilitation personnel of the hospital for being the
measurement staff and for supervising the training groups. Especially, I want to
thank everyone who took part into the crazy crosstalk at the coffee table. Special
thanks to Jaana for kicking us onward.
I want to express my thanks to my colleagues and fellow doctoral students
at the Department of Health Sciences for always helping me with problematic
situations. Thanks to Nick Hayward PhD for revising the language of this thesis.
The very special thanks are dedicated to the persons with knee
osteoarthritis and with knee replacement, who took part in the study. Thank
you for your patience at the measurement sessions and enthusiasm during the
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aquatic resistance training. Special thanks goes to the tiny 75-year-old lady who
always spurred others to train harder.
I am grateful for the financial support that I have received for performing
my doctoral thesis. This study and my doctoral studies were financially
supported by personal grants from Kymenlaakso Central Hospital Research
Fund (EVO), the Juho Vainio Foundation and the Finnish Cultural Foundation
Kymenlaakso Regional Fund.
Finally, I want to express my dearest thanks to my husband Kari for all
your love, patience and support throughout our years together. I also want to
thank our lovely kids Viia and Vertti for bringing so much joy into my life and
for keeping my feet on the ground. My deepest gratitude goes to my parents
Helena and Jukka for always supporting me with all my decisions throughout
my life and for proudly presenting me as the first PhD of the family. Thanks to
my mother-in-law Eeva and my father-in-law Rauno for accepting me into the
family and helping us with the kids. I am very thankful to my dearest friend
Jenni for listening, listening and listening to me during this occasionally painful
process. Thanks also go to my other very dear friends, relatives and my sister
Niina for always being there for me. You all made this possible.

Vantaa, February 2013

Anu Valtonen
(cid:3)

LIST OF ORIGINAL PUBLICATIONS
This thesis is based on the following original publications, which are referred to
by their Roman numerals. Additionally, some unpublished data are included in
the thesis.

I Valtonen A, Pöyhönen T, Manninen M, Heinonen A, Sipilä S.
Asymmetrical knee extensor power deficit slows stair ascension in
patients with end-stage knee osteoarthritis: A cross-sectional study.
Submitted for publication.

II Valtonen A, Pöyhönen T, Heinonen A, Sipilä S. 2009. Muscle deficits
persist after unilateral knee replacement and have implications for
rehabilitation. Phys Ther 89, 1072-1079.

III Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. 2010. Effects of aquatic
resistance training on mobility limitation and lower limb impairments
after knee replacement (ISRCTN50731915). Arch Phys Med Rehabil 91,
833-839.

IV Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. 2011. Maintenance of
aquatic training-induced benefits in mobility and lower extremity muscles
among persons with unilateral knee replacement. Arch Phys Med Rehabil
92, 1944-1950.