Abstract
Summary
It is uncertain whether subjects with mild knee osteoarthritis, and who may be at risk of osteoporosis, can exercise safely with the aim of improving hip bone strength. This RCT showed that participating in a high-impact exercise program improved femoral neck strength without any detrimental effects on knee cartilage composition.
Introduction
No previous studies have examined whether high-impact exercise can improve bone strength and articular cartilage quality in subjects with mild knee osteoarthritis. In this 12-month RCT, we assessed the effects of progressive high-impact exercise on femoral neck structural strength and biochemical composition of knee cartilage in postmenopausal women.
Methods
Eighty postmenopausal women with mild knee radiographic osteoarthritis were randomly assigned into the exercise (n = 40) or control (n = 40) group. Femoral neck structural strength was assessed with dual-energy X-ray absorptiometry. The knee cartilage region exposed to exercise loading was measured by the quantitative MRI techniques of T2 mapping and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). Also, an accelerometer-based body movement monitor was used to evaluate the total physical activity loading on the changes of femoral neck strength in all participants. Training effects on the outcome variables were estimated by the bootstrap analysis of covariance.
Results
A significant between-group difference in femoral neck bending strength in favor of the trainees was observed after the 12-month intervention (4.4%, p < 0.01). The change in femoral neck bending strength remained significant after adjusting for baseline value, age, height, and body mass (4.0%, p = 0.020). In all participants, the change in bending strength was associated with the total physical activity loading (r = 0.29, p = 0.012). The exercise participation had no effect on knee cartilage composition.
Conclusion
The high-impact training increased femoral neck strength without having any harmful effect on knee cartilage in women with mild knee osteoarthritis. These findings imply that progressive high-impact exercise is a feasible method in seeking to prevent hip fractures in postmenopausal women whose articular cartilage may also be frail.
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Acknowledgements
The authors are grateful to Dr. Risto Ojala (Oulu University Hospital) for reading the radiographs, Katriina Ojala, MSc. (UKK Institute, Tampere) for designing and tutoring the exercise programs, and Dr. Katri Lihavainen (University of Jyväskylä) for acting as an exercise instructor in charge. We also thank all the participants for their valuable contribution to the study.
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The study protocol was approved by the Ethics Committee of the Central Finland Health Care District (Dnro1E/2008). The protocol conformed to the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.
Conflicts of interest
RA and TJ are the inventors of patent application FI 20090320. Juhani Multanen, Timo Rantalainen, Hannu Kautiainen, Miika T. Nieminen, Eveliina Lammentausta, Arja Häkkinen, Ilkka Kiviranta, and Ari Heinonen declare that they have no conflict of interest.
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Multanen, J., Rantalainen, T., Kautiainen, H. et al. Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis: a 12-month RCT. Osteoporos Int 28, 1323–1333 (2017). https://doi.org/10.1007/s00198-016-3875-1
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DOI: https://doi.org/10.1007/s00198-016-3875-1