The Effect of Aquatic Exercise on Symptoms, Function, Body Composition and Cartilage in Knee

264 Pages·2016·17.2 MB·English

by  Waller, Benjamin

STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH
250
BJeennnjai mKiunl mWaalaller
The Effect of Aquatic Exercise
on Symptoms, Function, Body
Composition and Cartilage in Knee
Osteoarthritis
STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH 250
Benjamin Waller
The Effect of Aquatic Exercise on Symptoms,
Function, Body Composition and Cartilage in
Knee Osteoarthritis
Esitetään Jyväskylän yliopiston liikuntatieteellisen tiedekunnan suostumuksella
julkisesti tarkastettavaksi yliopiston vanhassa juhlasalissa S212
joulukuun 9. päivänä 2016 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 Seminarium, auditorium S212, on December 9, 2016 at 12 o’clock noon.
UNIVERSITY OF JYVÄSKYLÄ
JYVÄSKYLÄ 2016
The Effect of Aquatic Exercise on Symptoms,
Function, Body Composition and Cartilage in
Knee Osteoarthritis
STUDIES IN SPORT, PHYSICAL EDUCATION AND HEALTH 250
Benjamin Waller
The Effect of Aquatic Exercise on Symptoms,
Function, Body Composition and Cartilage in
Knee Osteoarthritis
UNIVERSITY OF JYVÄSKYLÄ
JYVÄSKYLÄ 2016
Editors
Ina Tarkka
Faculty of Sport and Health Sciences, University of Jyväskylä
Pekka Olsbo, Timo Hautala
Publishing Unit, University Library of Jyväskylä
Cover photo: KICK, KICK, KICK (Ben Waller 2013)
URN:ISBN:978-951-39-6850-2
ISBN 978-951-39-6850-2 (PDF)
ISBN 978-951-39-6849-6 (nid.)
ISSN 0356-1070
Copyright © 2016, by University of Jyväskylä
Jyväskylä University Printing House, Jyväskylä 2016
ABSTRACT
Waller, Benjamin
The Effect of Aquatic Exercise on Symptoms, Function, Body Composition and Cartilage in
Knee Osteoarthritis
Jyväskylä: University of Jyväskylä, 2016, 145 p.
(Studies in Sport, Physical Education and Health,
ISSN 0356-1070; 250)
ISBN 978-951-39-6849-6 (nid.)
ISBN 978-951-39-6850-2 (PDF)
Finnish summary
Diss.
Knee osteoarthritis (OA) is the most common joint disease associated with pain and loss of
functional capacity. The management of knee OA is multifaceted and covers the whole OA
continuum from injury prevention to the end stage of the disease. Recently, specific focus
has been on preventing the progression of cartilage degeneration and avoiding loss of
function in the early phase of the disease via the provision of exercise interventions.
Aquatic exercise is a popular but under-researched exercise option. Therefore, the purpose
of this dissertation was to investigate the role of aquatic exercise in the management of
knee OA, focusing especially the effect it evokes on both functional capacity and
biochemical composition of knee cartilage.
Two systematic reviews with meta-analysis were performed. The first investigated
the effect of therapeutic aquatic exercise on pain and functional capacity, compared to
controls, in individuals with lower limb OA; it included 11 studies. The second review
evaluated the effects of aquatic exercise on different aspects of functional capacity, e.g.
muscle strength, agility and walking ability, compared to control and land-based exercise,
in healthy older adults and included 28 studies. Data from a 4-month randomised
controlled trial with a 12-months’ follow-up period was used to investigate the effect of a
progressive aquatic resistance training program on walking ability, cardiovascular fitness,
muscle strength, symptoms and body composition in 87 postmenopausal women with mild
knee OA. Furthermore, the effect of the intervention on the biochemical composition of
tibiofemoral cartilage was investigated using T2 relaxation time (T2) mapping and delayed
gadolinium-enhanced magnetic resonance imaging (dGEMRIC index).
The results of this dissertation revealed that therapeutic aquatic exercise produced a
small sized but statistically significant decrease in pain and improvement in walking ability
and joint flexibility in individuals with lower limb OA. Compared to control interventions,
aquatic exercise significantly improved muscle strength, agility, flexibility, walking speed
and aerobic fitness in healthy older adults. Aquatic exercise was at least as effective as
land-based exercise at improving functional capacity in healthy older adults. Following 4-
months of aquatic resistance training, there was a significant increase in walking speed,
improved cardiovascular fitness and a decrease in fat mass. Only improvements in walking
speed were maintained at the 12-months’ follow-up. Additionally, a small effect in the
biochemical composition of the tibiofemoral cartilage was detected post-intervention in
both T2 and dGEMRIC index. To conclude, aquatic exercise exerts a positive effect on
different aspects of functional capacity in both healthy adults and individuals with knee
OA. The effect of aquatic exercise on the composition of cartilage needs to be clarified.
Keywords: osteoarthritis, aquatic exercise, qMRI, cartilage, walking ability
Author’s address Benjamin Waller, MSc, PT
Department of Health Sciences
University of Jyväskylä
P.O. Box 35
FI-40014 University of Jyväskylä, Finland
[email protected]
Supervisors Professor Ari Heinonen
Department of Health Sciences
University of Jyväskylä
Jyväskylä, Finland
Professor Urho Kujala
Department of Health Sciences
University of Jyväskylä
Jyväskylä, Finland
Professor Arja Häkkinen
Department of Health Sciences
University of Jyväskylä and
Department of Physical Medicine and Rehabilitation
Central Finland Health Care district
Jyväskylä, Finland
Reviewers Professor Hans Lund
Research Unit for Musculoskeletal Function and
Physiotherapy, Department of Sports Science and
Clinical Biomechanics
University of Southern Denmark
Odense, Denmark
Martin van der Esch, PhD
Reade Centre for Rehabilitation and Rheumatology
Amsterdam Rehabilitation Research Centre
Amsterdam, The Netherlands
Opponent Professor Ewa Roos
Research Unit for Musculoskeletal Function and
Physiotherapy, Department of Sports Science and
Clinical Biomechanics
University of Southern Denmark
Odense, Denmark
Dedicated to my girls Hilma, Saimi, Isla and my beautiful wife, Katja.
Love you forever.

"Lack of activity destroys the good condition
of every human being, while movement and
methodical physical exercise save it and
preserve it"

Plato
ACKNOWLEDGEMENTS
This dissertation was carried out in the Department of Health Sciences,
University of Jyväskylä, in collaboration with the Department of Diagnostic
Radiology, Oulu University Hospital, the Research Unit of Medical Imaging,
Physics and Technology, University of Oulu and the Medical Research Center,
University of Oulu and Oulu University Hospital. I have been honoured to be
part of the ‘AQUAREHAB’ project and work within a group of highly respected
and knowledgeable researchers. I am extremely grateful for the learning
opportunities and facilities provided to me by the Department of Health
Sciences, throughout the past five years since the initiation of my doctoral
studies.
I owe a debt of gratitude to Professor Ari Heinonen, PhD who acted as my
principal supervisor for my PhD project. Ari’s perseverance in convincing me to
return to academia represents a turning point in my life; without his
perseverance, I would have turned down this opportunity of a lifetime. Ari -
you also have the patience of a saint, when some may have reined in my
sometimes misdirected enthusiasm for additional projects, you gave me space
and considerable support to proceed with these projects. Importantly, you
always got the first round in and our frequent discussions about fishing made
being a PhD student under your mentorship an enjoyable experience.
I would like to express my special thanks to my two other supervisors,
Professor Urho Kujala, MD, PhD, and Professor Arja Häkkinen, PhD. Urho -
considering that you have such a huge work load, you always had time to
answer my questions and give instant feedback, when necessary. I was always
keen to read your comments on my work as you always provided new and
valuable perspectives. Arja - I could always expect an honest appraisal of my
work from you. I want to thank you in particular for the positive words of
encouragement you gave throughout the period of my studies. I always left our
discussions with a reinvigorated passion for my work.
Writing a good PhD requires significant input from others. I want to
specifically thank Professor Hans Lund, PhD, and Peter van der Esch, PhD, for
their huge work in reviewing my dissertation. Your comments and feedback
contributed greatly to the finished work and improved its content
immeasurably. I would like to thank Professor Ewa Roos, PhD, for agreeing to
be my opponent in the public defence of this dissertation. Further, I thank
Adjunct Professor Ina Tarkka, PhD, for the scientific editing and Ewen
MacDonald, PhD, for the language revision of this dissertation.
This dissertation was completed with the assistance of two research
groups, both of which I want to thank. To the members of the AQUAREHAB
team, your expertise and contributions to this work have been immense. In
particular, I thank Professor Miika Nieminen, PhD, Eveliina Lammentausta,
PhD, Arttu Peuna, MSc, and Victor Casula, MSc. Your support and knowledge
with the methodology and segmentation of the MRI imaging made this
dissertation possible. Your patience in teaching this physiotherapist how to
read and segment MRI images is highly appreciated. My gratitude goes to our
biostatistician, Hannu Kautiainen, your assistance with the statistics and
interpretation of our data enhanced the quality of my results. I thank also all of
the other members of the AQUAREHAB project for their valuable contributions:
Professor Sarianna Sipilä, Ilkka Kiviranta, MD, PhD, Harri Selänne, MD, PhD,
the late Tapani Pöyhönen, PhD, and Juha Paloneva, MD. I was lucky also to be
involved in a second research group lead by Professor Daniel Daly and Johan
Lambeck, and from this collaboration two of my papers originated. Dan and
Johan - you are both wholly responsible for building my interest in aquatic
therapy research starting with the Aquaevidence project back in 2007. Johan,
your experience and links to the clinical application of aquatic therapy research
have been essential in guiding my thought processes and research interests.
Very special thanks go to my colleague, roommate and sparring partner,
Matti Munukka, MSc, for making my PhD studies possible. Every great
research team requires players with different skills and without your
organisational skills, clear thinking and extreme tolerance of my sense of
humour, I would not have achieved anything like I have over the past 5 years.
My colleague, Juhani Multanen, PhD, - I thank you for contributions to the
AQUAREHAB project, without your years of experience and endless support,
our project would have been so much poorer. Every team needs a Timo and I
am so grateful we had one, even though it was only for one year; Timo
Rantalainen, PhD, - your assistance with the data collection and analysis was
invaluable and your comment “it is what it is” helped us to cope with many
difficult situations. Simon Walker, PhD, and Neil Cronin, PhD, - I thank you for
helping with bouncing ideas around, giving different interpretations of my
work and for your natural ability to put me right at any time; it was greatly
appreciated and often much needed. Thanks go to all the other PhD students
and Master’s degree students who dedicated a large amount of their time by
participating in the project with the outcome measures and supervising the
aquatic training. A big thank you goes also to Anna Ogonowska-Słodownik,
PhD, Karina Ostrovska, Msc, and Manuel Vitor, Msc, for your considerable
input into the data collection for both systematic reviews.
This doctoral dissertation and related research were funded by the
Academy of Finland, The Social Insurance Institution of Finland (KELA),
Finnish Cultural Foundation, Yrjö Jahnsson Foundation and Research Center
for Sport and Health Sciences (LIKES). I would like to thank Eino Havas, MSc,
and Tuija Tammelin, PhD, from LIKES who not only supported and were
central in convincing me to start my PhD studies but also financially supported
this work.
I owe a deep gratitude to my aquatic therapy colleagues for their
discussions, emotional support and company at the many aquatic therapy
related congresses that I have had the privilege to attend. After moving to
Finland, I have been blessed with making a large number of very good friends
who have supported me socially before and then all through my PhD period.
You know who you are!