| As a degenerative musculoskeletal system disease (DMSC) with the highest incidence in the elderly population, knee osteoarthritis (KOA) is one of the major chronic diseases contributing to dysfunction in this population. Both KOA and cardiovascular disease are 2 major risk factors causing impaired activities of daily living (ADL) in the elderly people. As a safe and effective way to improve the symptoms and dysfunction in patients with KOA, exercise therapy has been a hot academic research topic. Currently, most researches only focus on the effect of different strength training methods on the improvement in pain symptoms in patients with KOA, with single and limited intervention methods which can’t comprehensively evaluate the intervention effect. In this study, a functional exercise scheme was designed and employed for elderly KOA patients, including functional strength, flexibility, and proprioception exercise and so on. This study was aimed at comparing the effect of this comprehensive functional exercise vs. lower limb resistance exercise of gradual increase of elastic strap on elderly KOA patients, investigating the intervention effect in terms of physiological parameters and improvement in symptoms, function as well as quality of life, and exploring and analyzing the relationship between the effect on exercise intervention and genetic polymorphism of ASPN, GDF5, COL2A1, ESR1, VDR and IL6 related to elderly KOA patients.50 elderly patients (≥55 years) with unilateral KOA were screened through recruitment, questionnaire survey and routine physical examination and were randomly divided into 2 groups:the functional exercise group (n=25) and the strength training group (n=25), which received the functional exercise scheme (including functional strength, flexibility, proprioception exercise and so on) and the lower limb resistance exercise of gradual increase of elastic strap, respectively, with a frequency of 5 days/week for a total of 3 months. The effects of 2 different intervention methods were observed in elderly KOA patients. The testing indicators included physiological parameters, evaluation of the improvement in symptoms, function testing as well as gene polymorphism. The results showed that:1. Physiological parameters:The lower extremity strength and lean body mass significantly increased in both groups compared with those before intervention (P<0.05). The peak torque, average power and peak torque to body weight ratio of knee extension, the peak torque and average power of knee bending and so on in the functional exercise group showed more significant improvement than those in the strength training group(P<0.05).2. Improvement in clinical symptoms and function:VAS score of pain and function improvement, Lequene and Mery knee osteoarthritis severity index score and treatment effect score of JOAknee osteoarthritis showed a significant difference between the 2 groups(P<0.05). There was also a significant difference between them in covariance test (P<0.05).As to balance ability test, many subjects’parameters showed increased balance ability (P<0.05) and reduced fall risk index (P<0.05) in the functional exercise group. Only the total static balance score was improved than that before exercise and the fall risk index was reduced in the strength training group (P<0.05). There was a statistically significant difference between the 2 groups in stability limit time and fall risk index by covariance test (P<0.05).Among 4 parameters of lower limb function test, sit and antexion and 6-minute walk in the functional exercise group were improved. In the strength training group, sit and antexion and 6-minute walk were improved compared with those before exercise (P<0.05), while 2.5-meter shuttle run was decreased (P<0.05). There was a statistically significant difference between the 2 groups in the 4 parameters of lower limb function test by covariance test (P<0.05).3. Relevance of the gene polymorphismThe analysis results of the relationship between the initial value of the test parameters and gene polymorphism showed that:In GDF-5 gene rs 143383 subgroup, the stability limit time in GG group was lower than that in AG group (p<0.05) and the risk of falling is lower in AA group than that in AG group (p<0.05).In COL2A1 gene rs2276454 subgroup, the total stability limit score in AA group was lower than that in AA and AG group (p<0.05), the risk of falling is lower in AA group than that in AG group (p<0.05), and sit and antexion score in GG group was lower than in AA and AG group (p<0.05).In the subgroup of VDR gene rs7975232, the capacity of 2.5-meter shuttle run was better in AA group than that in CC group (p<0.05).In the subgroup of ESR1 gene rs9340799, the longitudinal index score was lower in AA group than that in GA group (p<0.05), the 30-second standing up score in GA group was higher than that in AA group(p<0.05), and the 6-minute walk in GA group was longer than that in AA group (p<0.05).The analysis results of the relationship between the test index difference and the gene polymorphism in elderly KOA patients before and after 12-week exercise intervention showed that:In GDF-5 gene rsl43383 subgroup, the increase of the lower limb bone density in GG group in functional exercise group after 12-week exercise was more obvious than GA and AA groups(p<0.05).In the subgroup of COL2A1 gene rs2276454, the reduction of falling risk after 12-week exercise intervention in AA group in the strength training group was statistically significant different from other 2 groups(p<0.05). The systemic bone density after 12-week exercise intervention in AA group in strength training group was reduced, which was statistically significant different from GG group and GA group (p<0.05).The following conclusions can be drawn based on the discussion and analysis of the experimental results:1.12-week functional exercise and 12-week resistance exercise of elastic strap all significantly increased the muscular strength of the lower extremities, remarkably improving symptoms and activities of daily living in elderly subjects with KOA. Compared with the single resistance exercise of elastic strap, the functional, flexible and proprioceptive exercise showed better intervention effects.2. In this study, it is easier for patients to accept and adhere to the functional exercise schedule and this intervention treatment is more effective. In view of this, exercise intervention in elderly KOA patients in the future should first consider the comprehensiveness of the exercise, including functional strength, flexibility, and proprioception and so on.3. There is a relationship between the balance ability and activities of daily living and the gene polymorphism of GDF-5 gene rs/143383, COL2A1 gene rs/2276454, VDR gene rs/7975232 and ESR1 gene rs/9340799 in elderly patients with KOA.4. There is a relationship between the effect of exercise intervention on balance ability and activities of daily living and the gene polymorphism of GDF-5 gene rs/143383, COL2A1 gene rs/2276454 in elderly patients with KOA. |
PDF Full Text Request