| Objective: Knee Osteoarthritis(OA) is the most common joint disease among elderly adults, and it can impair their independent living. The series of problems caused by knee OA has become not only the patients’ concern, but also their families’ and the whole societies’. Also, taking into consideration the factors such as age and illness, doing sport exercises is a challenge for elderly patients with OA, and it is essential to determine the appropriate exercises for them. Therefore, based on the characteristic of knee OA patients, the research team designed and developed a targeted tai chi rehabilitation program. The purpose of this study is to perform a six-month Tai Chi / educational intervention on elderly patients with knee OA using the newly targeted tai chi rehabilitation program. To determine the effect of intervention, we evaluated the clinical rehabilitation outcome and walking ability using sports biomechanics and sports medicine research methods Our study aimed to provide scientific proof to validate the effectiveness of targeted tai chi rehabilitation program among elderly patients with knee OA, it also aimed to provide an empirical basis for the promotion of Tai Chi as an exercise.Methods: 102 elderly women were recruited for this study from three communities: Lanxin, Guohe, and Dongfang from the Wujiaochang Town. Among all subjects, 71 subjects were knee OA patients and 31 were free from knee OA. Subjects were divided into three groups: Tai Chi intervention group(21, 64.20 ± 3.05), educational intervention group(19, 64.53 ± 3.51) and healthy group(22, 64.27 ± 2.31).The subjects in Tai Chi intervention group practiced the targeted tai chi exercise three times a week for six month. Each practice lasted one hour, including a 5-minute warm up, 50-minute tai chi practice, and 5-minute cool down. The subjects in educational intervention group attended seminars about OA every two weeks, each seminar included a 40-minute lecture section and 20-minute-question section The subjects in healthy group did not have any intervention. Before and after the six-month Tai Chi / educational intervention, all subjects completed visual analog pain scale test, Berg Scale, 10-meter walking and “get-up and go” test. Parameters included weight, height, walking ability and balance index were measured using PRODIGY Primo Direct Digital DEXA Bone Densitometry from Sports Science Museum in Shanghai University of Sports. The three lower limb joints(hip, knee, and ankle) data were synchronously collected using motion capture system, Kistler 3-D force platform and wireless Delsys surface EMG sensor in the biomechanics lab while subjects walking on a 10 m walkway. Measured variables included joint kinematics and ground reaction forces. EMG signals were collected in major muscle groups of the lower limb(biceps femoris, rectus femoris, vastus medialis, vastus lateralis, medial gastrocnemius, lateral gastrocnemius, and tibialis anterior). Visual3 D and EMG works were used to process and analyze collected data.Results: After the six months Tai Chi / educational interventions, the results showed that both left and right knee pain was significantly alleviated in Tai Chi group, and the right side has been improved more significantly than the left. In Tai chi group, Berg score(scores rise), 10 m walking speed(shortened) and “up and go”test(shortened) were significantly improved. However, no difference has been found in the educational intervention group(p>0.05). In Tai Chi group, subjects’ body weight and BMI were decreased, and there is a statistically significant difference(p <0.01); in education group, slightly decrease in weight and BMI has also been found(p<0.01). Lower limb muscle volume decreased in both groups, and no difference has been found between the two groups. Lower limb bone mineral density was not affected by the intervention. Total time gait cycle, the left and right step length, single support time and maximum vertical force on the left foot were not statistically different in both groups., about one foot above indicators coefficient of variation were less than 12.5%; step left foot symmetry index was increased in the Tai Chi group and decreased in the educational group after the intervention, and the values are <10%; both groups showed the same increasing trend in support maximum vertical force ASI, and the values were <10%. The COP displacement difference between two foots and average speed in Tai Chi group and educational group were significantly reduced. Hip flexion angle at touchdown did not change significantly(p>0.05). Knee flexion angle did not change significantly in tai chi group, it increased significantly in educational group; Ankle flexion angle on the right foot significantly increased in tai chi group(p<0.05). The maximum knee abduction moment on the left leg significantly decreased in Tai chi group. The contribution of the quadriceps muscles and hamstrings did not change in either Tai Chi group or educational group. The contribution of the two calf muscle triceps decreased in both Tai Chi group and educational group. The decrease in Tai Chi group(p<0.01) was more significant than the decrease in the educational group(p<0.05). The contribution of two calf muscles before rising movement was significantly increased in the educational group(p<0.01). In tai chi group, the contribution of the lower limb muscles was unchanged. The main contribution of the lower limb muscle groups was changed from the triceps muscle(28%) to the calf muscles(42%) in the educational group.Conclusion: The 6-month targeted Tai Chi intervention significantly alleviated the Knee OA pain, stiffness, and improved joint function, balance capacity and walking ability. It also effectively slowed down the process of muscle loss and aging-related bone osteoporosis among old adults. Although the intervention did not change the walking patterns of Knee OA patients, it still affected the step length and step frequency symmetry. It also contributed to reducing the magnitude of body shaking during walking and improving postural stability. In educational group, the results also showed improved stability, suggesting that the health education might be beneficial to be involved in the treatment and rehabilitation for Knee OA patients. After 6 months, compensatory at the ankle increased in the educational group, and knee abduction moment was significantly decreased in the Tai Chi group. Apart from these, other parameters did not change. This indicated that that Tai Chi did not change gait pattern or sport mode. However, it improved the patients’ ability in controlling body posture, which can slow down knee arthritis progress. After 6 months, the contribution of lower limb muscles did not change in the Tai Chi group. The main contribution of lower limb muscles changed from triceps muscles to front leg muscles in the educational group. This suggested that tai chi cannot strengthen leg muscles; however, it can restrict the loss of lower extremity muscle strength in patients with Knee OA. |
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