Exercise as it relates to Disease/The benefit of hydrotherapy and Tai Chi classes for sedentary osteoarthritis patients

This is an analysis of the journal article”Physical activity for osteoarthritis management: A randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes” by Fransen, Nairn, Winstanley, Lam and Edmonds (2007).

What is the background to this research?
Osteoarthritis is a degenerative condition causing pain, swelling and loss of motion due to breakdown of cartilage that covers the ends of the bones in joints around the body causing the bones to rub together. This study focuses on physical activity interventions to improve quality of life for osteoarthritic patients, “physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure.” Results from the 2011–12 National Health Survey propose that approximately 1.8 million Australians (8% of the population) have Osteoarthritis with the prevalence of the condition rising with age. Many osteoarthritic individuals are sedentary due to the pain experienced however this study used low-impact 12 week exercise programs utilising hydrotherapy and Tai Chi to assess the adherence of participants, and whether the programs provide measurable improvements in joint pain and physical function.

The relevance of this research corresponds with Australia’s ageing population and the increasing amount of osteoarthritis cases that places a $1.6 billion burden on Australia’s healthcare system and decreases the quality of life of individual’s experiencing the condition.

Where is the research from?
This study was conducted by researchers from the University of Sydney and was registered with the National Institutes of Health and approved by the South Eastern Sydney Area Health Service Human Research Ethics Committee.

What kind of research was this?
The study was a randomized controlled trial among 152 older adults aged 59–85 years with chronic symptomatic hip or knee Osteoarthritis.

What did the research involve?
The random sample of 152 participants were randomly allocated into 1 of 3 groups for 12 weeks, the groups included hydrotherapy classes (n = 55), Tai Chi classes (n = 56), or a waiting list control group (n = 41). The participants allocated to the hydrotherapy and Tai Chi groups were required to attend 1 hour classes, twice a week for 12 weeks at St George Public Hospital. Assessments were conducted on participants at pre-treatment, 12 weeks for post-treatment and 24 weeks for a follow-up. Primary outcomes measured included pain and physical function of participants using the Western Ontario and McMaster Universities Osteoarthritis Index, the scores were standardised to a 0-100 range with higher scores indicating greater pain or physical disability. Secondary outcomes measured included general health status using the Medical Outcomes Study Short Form 12 Health Survey [SF-12], psychological well-being, and physical performance measured by an Up and Go test, 50-foot walk time and timed stair climb.

What were the basic results?
Treatment adherence was defined as participants attending 12 or more of the available 24 classes allocated to hydrotherapy was 81% and 61% of the Tai Chi group. In summary the study indicated that access to organised physical activity classes improved symptoms of osteoarthritis however low impact physical activity proved to be popular among participants, with the hydrotherapy group having the highest adherence to the exercise program.

Primary Outcomes

Hydrotherapy and Tai Chi groups both indicated significant improvements compared to the control group for measures of pain and function.

Secondary Outcomes

Hydrotherapy improved all 3 physical performance measures of up and go test, 50-foot walk time and timed stair climb, whereas the Tai Chi group only improved significantly in the timed stair climb.

Follow up Assessment

The significant results achieved at 12 weeks were generally sustained for 3 months after conclusion of classes.

What conclusions should be taken away from this research?
This research demonstrates that exercise is an effective intervention for increasing physical activity and reducing symptoms among older individuals experiencing osteoarthritis of the hip or knee joints. The results indicated measurable improvements at post-treatment and additionally the results were sustained for 12 weeks after the programs conclusion. The increase of availability of Tai Chi and hydrotherapy classes for individuals experiencing osteoarthritis would benefit the patient’s quality of life.

Practical advice
This study shows that the low impact physical activity is the key for osteoarthritic patients, however the study highlights that non-weight bearing exercise is more ideal than exercises such as Tai Chi. Further studies could incorporate more non-weight bearing exercises such as water aerobics, this would encourage adherence to the study. Future studies could also assess different variabilities of the participants such as barriers to exercise and interventions to overcome the barriers, for example, researchers could experiment the effect of taping the knee joint with osteoarthritis and the effect the intervention has on participation. The methods used for the study has some implications on the research that include:
 * Researchers did not track whether participants completed physical activity in their own time outside the study's exercise program.
 * The primary measure of pain is based off the subjects self-report, which compromises the reliability of the study.
 * The study is narrowed to a specific age group of older adults, which questions the relevance to the general osteoarthritis population.

The real world relevance of the study varies between individuals depending on their condition, availability of classes, transport, and location of the sessions. However, the study indicates that exercise as an intervention is successful, the next step is to find exercise alternatives for individuals with barriers to accessing Tai Chi and hydrotherapy.