Original article
Effects of Aquatic Resistance Training on Mobility Limitation and Lower-Limb Impairments After Knee Replacement

Presented to the Congress of Medicine and Science in Sports, November 11, 2006, Vierumäki, Finland; the World Congress of Physical Therapy, June 5, 2007, Vancouver, BC, Canada; and the European College of Sport Sciences, July 12, 2007, Jyväskylä, Finland.
https://doi.org/10.1016/j.apmr.2010.03.002Get rights and content

Abstract

Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement.

Objective

To study the effects of aquatic resistance training on mobility, muscle power, and cross-sectional area.

Setting

Research laboratory and hospital rehabilitation pool.

Participants

Population-based sample (N=50) of eligible women and men 55 to 75 years old 4 to 18 months after unilateral knee replacement with no contraindications who were willing to participate in the trial.

Interventions

Twelve-week progressive aquatic resistance training (n=26) or no intervention (n=24).

Main Outcome Measures

Mobility limitation assessed by walking speed and stair ascending time, and self-reported physical functional difficulty, pain, and stiffness assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee extensor power and knee flexor power assessed isokinetically, and thigh muscle cross-sectional area (CSA) by computed tomography.

Results

Compared with the change in the control group, habitual walking speed increased by 9% (P=.005) and stair ascending time decreased by 15% (P=.006) in the aquatic training group. There was no significant difference between the groups in the WOMAC scores. The training increased knee extensor power by 32% (P<.001) in the operated and 10% (P=.001) in the nonoperated leg, and knee flexor power by 48% (P=.003) in the operated and 8% (P=.002) in the nonoperated leg compared with controls. The mean increase in thigh muscle CSA of the operated leg was 3% (P=.018) and that of the nonoperated leg 2% (P=.019) after training compared with controls.

Conclusions

Progressive aquatic resistance training had favorable effects on mobility limitation by increasing walking speed and decreasing stair ascending time. In addition, training increased lower limb muscle power and muscle CSA. Resistance training in water is a feasible mode of rehabilitation that has wide-ranging positive effects on patients after knee replacement surgery.

Section snippets

Setting and Participants

In 2005, all 201 patients who according to the physical therapy records of Kymenlaakso Central Hospital had undergone unilateral knee replacement 4 to 18 months prior to the study were informed about the study. Eighty-six patients responded and were contacted by the research personnel and interviewed over the telephone. Patients with bilateral knee arthroplasty, revision arthroplasty, severe cardiovascular diseases, dementia, rheumatoid arthritis, or any major surgery in either of the knees

Baseline Characteristics

Table 2 shows the baseline physical characteristics of the training and control groups. No between-group differences were observed at baseline.

Program Feasibility

The dropout rate was 6%. In the training group, 1 participant (knee replacement operation on the other knee), and in the control group, 3 participants (1 for personal reasons and 2 for a knee replacement operation on the other knee) were lost to follow-up (see fig 1). Training compliance in the aquatic training sessions was excellent, averaging 98% (590

Discussion

The results of this study support our hypothesis and show that 12 weeks of progressive aquatic resistance training decreased mobility limitation in women and men 55 to 75 years old after unilateral knee replacement. In addition, knee extensor and flexor power and thigh muscle CSA increased with training, especially in the operated leg.

Our results showed training effects in the operated knee of 32% and 48% for knee extensor and flexor power, respectively. The corresponding values for the

Conclusions

The results of this randomized controlled trial showed that 12 weeks of progressive aquatic training reduced mobility limitation in persons with knee replacement. Knee extensor and flexor power and thigh muscle CSA increased with training, especially in the operated leg. The aquatic training was well tolerated, and thus water would appear to offer an effective environment for training muscle power and mobility after knee replacement.

References (46)

  • S.D. Martin et al.

    Current concepts of total knee arthroplasty

    J Orthop Sports Phys Ther

    (1998)

  • NIH consensus statement on total knee replacement December 8-10, 2003

    J Bone Joint Surg Am

    (2004)
  • D.L. Jones et al.

    Update on hip and knee arthroplasty: current state of evidence

    Arthritis Rheum

    (2005)
  • C.A. Jones et al.

    Health related quality of life outcomes after total hip and knee arthroplasties in a community based population

    J Rheumatol

    (2000)
  • J.D. Fitzgerald et al.

    Patient quality of life during the 12 months following joint replacement surgery

    Arthritis Rheum

    (2004)
  • E. Finch et al.

    Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability

    J Orthop Sports Phys Ther

    (1998)
  • P.C. Noble et al.

    Does total knee replacement restore normal knee function?

    Clin Orthop Relat Res

    (2005)
  • M. Walsh et al.

    Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects

    Phys Ther

    (1998)
  • R.L. Mizner et al.

    Quadriceps strength and the time course of functional recovery after total knee arthroplasty

    J Orthop Sports Phys Ther

    (2005)
  • M.D. Rossi et al.

    Knee extensor and flexor torque characteristics before and after unilateral total knee arthroplasty

    Am J Phys Med Rehabil

    (2006)
  • C.J. Minns Lowe et al.

    Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials

    BMJ

    (2007)
  • J.S. Lorentzen et al.

    Early changes in muscle strength after total knee arthroplasty: a 6-month follow-up of 30 knees

    Acta Orthop Scand

    (1999)
  • H. Gapeyeva et al.

    Quadriceps femoris muscle voluntary isometric force production and relaxation characteristics before and 6 months after unilateral total knee arthroplasty in women

    Knee Surg Sports Traumatol Arthrosc

    (2007)

    • Cited by (0)

    Supported by the Kymenlaakso Central Hospital Research Fund, the Juho Vainio Foundation, and the Finnish Cultural Foundation.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    This randomized controlled trial is registered as ISRCTN50731915.

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    Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.