year 10, Issue 3 (Autumn 2022)
Ann Appl Sport Sci 2022, 10(3): 0-0 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Hassabi M, Abedi Yekta A H, Poursaeid Esfahani M, Salehi S, Labibzadeh N. The Effects of Aerobic and Resistance Exercise Therapy with and without Weight Bearing on the Outcomes of Stem Cell Therapy for Knee Osteoarthritis: A Randomized Clinical Trial. Ann Appl Sport Sci 2022; 10 (3)
URL: http://aassjournal.com/article-1-1067-en.html
URL: http://aassjournal.com/article-1-1067-en.html
Mohammad Hassabi1 
, Amir Hosein Abedi Yekta2 , Mehrshad Poursaeid Esfahani2 , Shahin Salehi2 , Nargse Labibzadeh * 3
, Amir Hosein Abedi Yekta2 , Mehrshad Poursaeid Esfahani2 , Shahin Salehi2 , Nargse Labibzadeh * 3
1- Taleghani Hospital Research Development committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,ddrnlz@gmail.com
2- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,
Abstract: (2728 Views)
Background. The objective of this trial was to evaluate the effect of two exercise programs on patients undergoing the implantation of intraarticular stem cells.
Objectives. We performed a randomized trial on sixteen patients under 65 years old with moderate knee OA after stem cell therapy.
Methods. Patients were randomly divided into two groups of exercise therapy: weight-bearing (WB) and non-weight-bearing (non-WB). This program lasted 12 weeks, with follow-ups at 1 and 3 months. Primary outcomes were knee pain (visual analog scale (VAS)) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)). Secondary outcomes included: standing time, walking distance, pain-free walking distance, time to jelling, and a subscale of stiffness and pain of WOMAC.
Results. Fifteen patients were retained. No adverse effect was reported. There was a significant improvement in pain and physical function in both groups compared to the baseline. VAS: from 55±7.6 to zero (effect size of 1.34), total WOMAC: from 93.75±1.39 to 30.87±5.22 at 1-month and 21.87±6.99 at 3-month (1.88 and 2.73, respectively). For secondary outcomes, walking distance (from 750.0±267.26 meter to 2000.0±0.0 meter and 2500.0±0.0 meter, respectively, and time to jelling (at 3 months, from 5.00±0.0 minute to 35.00±16.90 minute) improved significantly better in WB group.
Conclusion. Both types of exercises were safe and improved primary and secondary outcomes. WB exercise has additional benefits of more pain reduction and functional improvement.
Objectives. We performed a randomized trial on sixteen patients under 65 years old with moderate knee OA after stem cell therapy.
Methods. Patients were randomly divided into two groups of exercise therapy: weight-bearing (WB) and non-weight-bearing (non-WB). This program lasted 12 weeks, with follow-ups at 1 and 3 months. Primary outcomes were knee pain (visual analog scale (VAS)) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)). Secondary outcomes included: standing time, walking distance, pain-free walking distance, time to jelling, and a subscale of stiffness and pain of WOMAC.
Results. Fifteen patients were retained. No adverse effect was reported. There was a significant improvement in pain and physical function in both groups compared to the baseline. VAS: from 55±7.6 to zero (effect size of 1.34), total WOMAC: from 93.75±1.39 to 30.87±5.22 at 1-month and 21.87±6.99 at 3-month (1.88 and 2.73, respectively). For secondary outcomes, walking distance (from 750.0±267.26 meter to 2000.0±0.0 meter and 2500.0±0.0 meter, respectively, and time to jelling (at 3 months, from 5.00±0.0 minute to 35.00±16.90 minute) improved significantly better in WB group.
Conclusion. Both types of exercises were safe and improved primary and secondary outcomes. WB exercise has additional benefits of more pain reduction and functional improvement.
Keywords: Knee, Non-Weight Bearing Exercise, Osteoarthritis, Sports Medicine, Stem Cells, Weight Bearing Exercise
Full-Text [PDF 594 kb]
(863 Downloads)
APPLICABLE REMARKS
APPLICABLE REMARKS
• After stem cell therapy for knee OA, patients should be encouraged to exercise programs, including WB and non-WB. It will improve the outcomes of stem cell therapy.
Type of Study: Original Article |
Subject:
Exercise, Training and Health
Received: 2021/10/1 | Accepted: 2021/11/18
Received: 2021/10/1 | Accepted: 2021/11/18
References
1. Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med. 2019;53(15):940-947. [DOI:10.1136/bjsports-2017-098661] [PMID]
2. Davatchi F. Rheumatic diseases in the APLAR region. APLAR J Rheumatol. 2006;9(1):5-10. [DOI:10.1111/j.1479-8077.2006.00177.x]
3. Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis. 2016;19(3):219-225. [DOI:10.1111/1756-185X.12670] [PMID]
4. Felson D. SP0193 Osteoarthritis Is A Disease Of Mechanics. Annal Rheumatic Diseas. 2013;72(Suppl 3):A44-A. [DOI:10.1136/annrheumdis-2013-eular.193]
5. Robinson WH, Lepus CM, Wang Q, Raghu H, Mao R, Lindstrom TM, et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(10):580-592. [DOI:10.1038/nrrheum.2016.136] [PMID] [PMCID]
6. Buckwalter JA. Sports, joint injury, and posttraumatic osteoarthritis. J Orthop Sports Phys Ther. 2003;33(10):578-588. [DOI:10.2519/jospt.2003.33.10.578] [PMID]
7. Schinhan M, Toegel S, Weinmann D, Schneider E, Chiari C, Gruber M, et al. Biological Regeneration of Articular Cartilage in an Early Stage of Compartmentalized Osteoarthritis: 12-Month Results. Am J Sports Med. 2020;48(6):1338-1346. [DOI:10.1177/0363546520906411] [PMID]
8. Xu Z, He Z, Shu L, Li X, Ma M, Ye C. Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Inhibiting Inflammation and Improving Pain and Function. Arthroscopy. 2021;37(3):903-915. [DOI:10.1016/j.arthro.2020.10.013] [PMID]
9. Gobbi A, Dallo I, Rogers C, Striano RD, Mautner K, Bowers R, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study. Int Orthop. 2021;45(5):1179-1188. [DOI:10.1007/s00264-021-04947-0] [PMID]
10. Wang AT, Feng Y, Jia HH, Zhao M, Yu H. Application of mesenchymal stem cell therapy for the treatment of osteoarthritis of the knee: A concise review. World J Stem Cells. 2019;11(4):222-235. [DOI:10.4252/wjsc.v11.i4.222] [PMID] [PMCID]
11. Emadedin M, Labibzadeh N, Liastani MG, Karimi A, Jaroughi N, Bolurieh T, et al. Intra-articular implantation of autologous bone marrow-derived mesenchymal stromal cells to treat knee osteoarthritis: a randomized, triple-blind, placebo-controlled phase 1/2 clinical trial. Cytotherapy. 2018;20(10):1238-1246. [DOI:10.1016/j.jcyt.2018.08.005] [PMID]
12. van Lent PL, van den Berg WB. Mesenchymal stem cell therapy in osteoarthritis: advanced tissue repair or intervention with smouldering synovial activation? Arthritis Res Ther. 2013;15(2):112. [DOI:10.1186/ar4190] [PMID] [PMCID]
13. Roelofs AJ, Rocke JP, De Bari C. Cell-based approaches to joint surface repair: a research perspective. Osteoarthritis Cartilage. 2013;21(7):892-900. [DOI:10.1016/j.joca.2013.04.008] [PMID] [PMCID]
14. Jiang S, Tian G, Li X, Yang Z, Wang F, Tian Z, et al. Research Progress on Stem Cell Therapies for Articular Cartilage Regeneration. Stem Cells Int. 2021;2021:8882505. [DOI:10.1155/2021/8882505] [PMID] [PMCID]
15. Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2021;325(6):568-578. [DOI:10.1001/jama.2020.22171] [PMID] [PMCID]
16. Tanaka S, Nishigami T, Wand BM, Stanton TR, Mibu A, Tokunaga M, et al. Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis-generating study. Eur J Pain. 2021;25(2):485-496. [DOI:10.1002/ejp.1687] [PMID]
17. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14(1):4-9. [DOI:10.1016/j.jsams.2010.08.002] [PMID]
18. Jakiela JT, Waugh EJ, White DK. Walk At Least 10 Minutes a Day for Adults With Knee Osteoarthritis: Recommendation for Minimal Activity During the COVID-19 Pandemic. J Rheumatol. 2021;48(2):157-159. [DOI:10.3899/jrheum.200914] [PMID]
19. Munukka M, Waller B, Hakkinen A, Nieminen MT, Lammentausta E, Kujala UM, et al. Physical Activity Is Related with Cartilage Quality in Women with Knee Osteoarthritis. Med Sci Sports Exerc. 2017;49(7):1323-1330. [DOI:10.1249/MSS.0000000000001238] [PMID]
20. Lin W, Alizai H, Joseph GB, Srikhum W, Nevitt MC, Lynch JA, et al. Physical activity in relation to knee cartilage T2 progression measured with 3 T MRI over a period of 4 years: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2013;21(10):1558-1566. [DOI:10.1016/j.joca.2013.06.022] [PMID] [PMCID]
21. Wondrasch B, Risberg MA, Zak L, Marlovits S, Aldrian S. Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle: a prospective, randomized controlled study presenting MRI-based and clinical outcomes after 5 years. Am J Sports Med. 2015;43(1):146-153. [DOI:10.1177/0363546514554910] [PMID]
22. Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005;52(11):3507-3514. [DOI:10.1002/art.21415] [PMID]
23. Bennell KL, Nelligan RK, Kimp AJ, Schwartz S, Kasza J, Wrigley TV, et al. What type of exercise is most effective for people with knee osteoarthritis and co-morbid obesity?: The TARGET randomized controlled trial. Osteoarthritis Cartilage. 2020;28(6):755-765. [DOI:10.1016/j.joca.2020.02.838] [PMID]
24. Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M, et al. Updating ACSM's Recommendations for Exercise Preparticipation Health Screening. Med Sci Sports Exerc. 2015;47(11):2473-2479. [DOI:10.1249/MSS.0000000000000664] [PMID]
25. Borg G, Ljunggren G, Ceci R. The increase of perceived exertion, aches and pain in the legs, heart rate and blood lactate during exercise on a bicycle ergometer. Eur J Appl Physiol Occup Physiol. 1985;54(4):343-349. [DOI:10.1007/BF02337176] [PMID]
26. Kellgren JH. Epidemiology of chronic rheumatism. Atlas of standard radiographs of arthritis.1963.
27. Fitzgerald GK, Hinman RS, Zeni J, Jr., Risberg MA, Snyder-Mackler L, Bennell KL. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of rehabilitation interventions for osteoarthritis. Osteoarthritis Cartilage. 2015;23(5):803-814. [DOI:10.1016/j.joca.2015.03.013] [PMID]
28. Messier SP, Callahan LF, Golightly YM, Keefe FJ. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of lifestyle diet and exercise interventions for osteoarthritis. Osteoarthritis Cartilage. 2015;23(5):787-797. [DOI:10.1016/j.joca.2015.03.008] [PMID]
29. Thumboo J, Chew LH, Soh CH. Validation of the Western Ontario and Mcmaster University osteoarthritis index in Asians with osteoarthritis in Singapore. Osteoarthritis Cartilage. 2001;9(5):440-446. [DOI:10.1053/joca.2000.0410] [PMID]
30. Brandt KD, Fife RS, Braunstein EM, Katz B. Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration. Arthritis Rheum. 1991;34(11):1381-1386. [DOI:10.1002/art.1780341106] [PMID]
31. Xiong J, Zhu D, Chen R, Ye W. Report quality of randomized controlled trials of moxibustion for knee osteoarthritis based on CONSORT and STRICTOM. Zhongguo zhen jiu= Chinese acupuncture & moxibustion. 2015;35(8):835-839.
32. Kabiri S, Halabchi F, Angoorani H, Yekaninejad S. Comparison of three modes of aerobic exercise combined with resistance training on the pain and function of patients with knee osteoarthritis: A randomized controlled trial. Phys Ther Sport. 2018;32:22-28. [DOI:10.1016/j.ptsp.2018.04.001] [PMID]
33. Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsoe B, Dagfinrud H, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3:CD005523. [DOI:10.1002/14651858.CD005523.pub3] [PMID]
34. Bennell KL, Hall M, Hinman RS. Osteoarthritis year in review 2015: rehabilitation and outcomes. Osteoarthritis Cartilage. 2016;24(1):58-70. [DOI:10.1016/j.joca.2015.07.028] [PMID]
35. Fallon K. The role of exercise in management of rheumatological disease. Aust J Gen Pract. 2021;50(5):271-274. [DOI:10.31128/AJGP-03-21-5865] [PMID]
36. Uthman OA, van der Windt DA, Jordan JL, Dziedzic KS, Healey EL, Peat GM, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347:f5555. [DOI:10.1136/bmj.f5555] [PMID] [PMCID]
37. Reza MK, Shaphe MA, Qasheesh M, Shah MN, Alghadir AH, Iqbal A. Efficacy of Specified Manual Therapies in Combination with a Supervised Exercise Protocol for Managing Pain Intensity and Functional Disability in Patients with Knee Osteoarthritis. J Pain Res. 2021;14:127-138. [DOI:10.2147/JPR.S285297] [PMID] [PMCID]
38. Hughes SL, Seymour RB, Campbell R, Pollak N, Huber G, Sharma L. Impact of the fit and strong intervention on older adults with osteoarthritis. Gerontologist. 2004;44(2):217-228. [DOI:10.1093/geront/44.2.217] [PMID]
39. Goh SL, Persson MSM, Stocks J, Hou Y, Welton NJ, Lin J, et al. Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Sports Med. 2019;49(5):743-761. [DOI:10.1007/s40279-019-01082-0] [PMID] [PMCID]
40. Whittaker JL, Truong LK, Dhiman K, Beck C. Osteoarthritis year in review 2020: rehabilitation and outcomes. Osteoarthritis Cartilage. 2021;29(2):190-207. [DOI:10.1016/j.joca.2020.10.005] [PMID]
41. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554-1557. [DOI:10.1136/bjsports-2015-095424] [PMID]
42. Juhl C, Christensen R, Roos EM, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66(3):622-636. [DOI:10.1002/art.38290] [PMID]
43. Multanen J, Nieminen MT, Hakkinen A, Kujala UM, Jamsa T, Kautiainen H, et al. Effects of high-impact training on bone and articular cartilage: 12-month randomized controlled quantitative MRI study. J Bone Miner Res. 2014;29(1):192-201. [DOI:10.1002/jbmr.2015] [PMID]
44. Mitchell HL, Hurley MV. Management of chronic knee pain: a survey of patient preferences and treatment received. BMC Musculoskelet Disord. 2008;9:123. [DOI:10.1186/1471-2474-9-123] [PMID] [PMCID]
45. Shadmanfar S, Labibzadeh N, Emadedin M, Jaroughi N, Azimian V, Mardpour S, et al. Intra-articular knee implantation of autologous bone marrow-derived mesenchymal stromal cells in rheumatoid arthritis patients with knee involvement: Results of a randomized, triple-blind, placebo-controlled phase 1/2 clinical trial. Cytotherapy. 2018;20(4):499-506. [DOI:10.1016/j.jcyt.2017.12.009] [PMID]
46. Johnstone B, Stoddart MJ, Im GI. Multi-Disciplinary Approaches for Cell-Based Cartilage Regeneration. J Orthop Res. 2020;38(3):463-472. [DOI:10.1002/jor.24458] [PMID]
47. Biazzo A, D'Ambrosi R, Masia F, Izzo V, Verde F. Autologous adipose stem cell therapy for knee osteoarthritis: where are we now? Phys Sportsmed. 2020;48(4):392-399. [DOI:10.1080/00913847.2020.1758001] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
