Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement.
OBJECTIVE
To study the effects of aquatic resistance training on mobility, muscle power, and cross-sectional area.


METHODS
Randomized controlled trial.


METHODS
Research laboratory and hospital rehabilitation pool.


METHODS
Population-based sample (N=50) of eligible women and men 55 to 75 years old 4 to 18 months after unilateral knee replacement with no contraindications who were willing to participate in the trial.


METHODS
Twelve-week progressive aquatic resistance training (n=26) or no intervention (n=24).


METHODS
Mobility limitation assessed by walking speed and stair ascending time, and self-reported physical functional difficulty, pain, and stiffness assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee extensor power and knee flexor power assessed isokinetically, and thigh muscle cross-sectional area (CSA) by computed tomography.


RESULTS
Compared with the change in the control group, habitual walking speed increased by 9% (P=.005) and stair ascending time decreased by 15% (P=.006) in the aquatic training group. There was no significant difference between the groups in the WOMAC scores. The training increased knee extensor power by 32% (P<.001) in the operated and 10% (P=.001) in the nonoperated leg, and knee flexor power by 48% (P=.003) in the operated and 8% (P=.002) in the nonoperated leg compared with controls. The mean increase in thigh muscle CSA of the operated leg was 3% (P=.018) and that of the nonoperated leg 2% (P=.019) after training compared with controls.


CONCLUSIONS
Progressive aquatic resistance training had favorable effects on mobility limitation by increasing walking speed and decreasing stair ascending time. In addition, training increased lower limb muscle power and muscle CSA. Resistance training in water is a feasible mode of rehabilitation that has wide-ranging positive effects on patients after knee replacement surgery.
Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. anu.m.valtonen@jyu.fi
Anu
A
Valtonen
Tapani
T
Pöyhönen
Sarianna
S
Sipilä
Ari
A
Heinonen
D000368:Aged; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D035002:Lower Extremity / Q000000981:diagnostic imaging / Q000502:physiology; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D053580:Muscle Strength / Q000502:physiology; D010147:Pain Measurement; D055070:Resistance Training / Q000379:methods*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome