Aerobic Vs Neuromuscular Exercise for Knee OA

Frederiksberg University Hospital150 enrolled

Overview

The study aims to compare the effects of an education and High Intensity Interval Training program (eHIIT) with the widely used Neuromuscular Exercise and education program (NEMEX-e) on knee OA symptoms and risk factors for cardiovascular disease in people with knee OA and at least one risk factor for developement of cardiovascular disease. The main research questions the study aims to answer are: * Is the eHIIT program better than the NEMEX-e program for reducing the risk of cardiovascular disease? * Are the two programs equally good at providing improvement in knee symptoms?

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

150

Conditions

Knee Osteoarthritis

Interventions

eHIIT

Education and High intensity Interval Training (Aerobic Exercise) The focus of the one educational session is rationale for aerobic exercise, expected physiological effects of aerobic exercise, diet when performing an exercise program, how the knee accommodates to exercise (including potential experience of muscle soreness and how that is different from joint pain), and management of potential knee OA symptom flares. HIIT is an aerobic exercise form. The eHITT protocol consist of eight 2-minute intervals of high intensity training (with the goal to train at a heart rate of at least 80% of HRmax) followed by 2 minutes of moderate training intensity (with the goal to train at a heart rate of at least 60% of HRmax). There will be several types of exercise modalities for aerobic exercise available (treadmills, cross-trainers, row- and cycle ergometers) and participants may choose whichever they prefer.

NEMEX-eBEHAVIORAL

Education and Neuromuscular Exercise The focus of the two educational sessions is on providing knowledge of OA and treatment options to the participants, with a special focus on knee OA, diet, and exercise and its benefits. Furthermore, advice about self-management is given. The exercises are based on neuromuscular principles to improve sensorimotor control and achieve compensatory functional stability. Sensorimotor control is the ability to coordinate muscle activity and maintain functional stability during movement allowing for joint stability during physical activity. Various positions (sitting, lying, standing) are used to achieve the desired postural activity. The overall goal is to obtain muscle control and stability in situations resembling daily life and/or more strenuous activities. The focus is on achieving good quality of the performance in each exercise with appropriate postural orientation (e.g., joint positioned appropriately in relation to each other).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥18- years * Diagnosis of tibiofemoral knee OA according to the American College of Rheumatology criteria * Radiographically confirmed diagnosis of tibiofemoral OA based on radiographs not older than 6 months. * Average knee pain level ≥ 4 (0=No pain and 10=Worst pain) over the past week (7 days) * At least one of following risk factors for development of cardiovascular disease: * Body mass index ≥ 30 kg/m2 * Hypertension (or in treatment of): Systolic ≥ 135 and/or diastolic ≥ 85 mm Hg * Elevated HbA1c (or in treatment of): ≥ 130.7 mg/dL (44 mmol/mol) * Elevated Triglycerides (or in treatment of): ≥ 150 mg/dL (1.7 mmol/L) * Elevated Cholesterol (or in treatment of) (Low density lipides, LDL): LDL ≥ 54 mg/dL (3.0 mmol/L) Exclusion Criteria: * Contraindication to exercise (e.g., resting systolic blood pressure \> 200 or diastolic blood pressure \> 115, acute or reoccurring chest pain) * Unstable body weight the last 3 months (gain/loss outside +/- 5 kg) * Planned weight loss (non-pharmacological, pharmacological, and surgical) during study participation * Known current cancer * Major cardiovascular event within the last 5 years * Insulin dependent type 1 or type 2 diabetes * Psoriatic, rheumatoid, or gouty arthritis disease * Generalized pain syndromes such as fibromyalgia * Lumbar or cervical nerve root compression syndromes * Scheduled surgery during study participation * Treatment with biological medication * Impairments that prevent performance in high intensity aerobic exercise * Current or planned participation in other health research intervention studies * Pregnant/considering pregnancy * Any other condition or impairment that, in the opinion of the investigator, makes a potential participant unsuitable for participation or which obstruct participation, such as a large knee joint effusion, uncontrolled diabetes/hypertension, psychiatric or cognitive disorders, language barriers, or opiate dependency.

Outcomes

Primary Outcomes

Maximal oxygen consumption (VO2max)

Cardiopulmonary exercise test (CPET) on an ergometer bicycle for evaluation maximal oxygen consumption (VO2max) measured in ml/min/kg

Time frame: Baseline and Week 12

Knee pain

The Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale (KOOS-pain), a disease-specific patient-reported instrument designed to assess knee pain in patients with knee osteoarthritis. The KOOS-pain subscale is scored on a 0-100 scale with 100 indicating no pain and 0 indicating extreme pain.

Time frame: Baseline and Week 12

Secondary Outcomes

Maximal oxygen consumption (VO2max)

Cardiopulmonary exercise test (CPET) on an ergometer bicycle for evaluation maximal oxygen consumption (VO2max) measured in ml/min/kg

Time frame: Week 8 and week 26

Knee pain

Time frame: Week 8 and week 26

Body Mass

Body mass measured in kilograms using a scale