title: Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial.
abstract: BACKGROUND
  Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis.
  
  
  METHODS
  A minimum of 80 volunteers who meet the inclusion criteria will be recruited from the local population through newspaper advertisements. Following initial assessment volunteers will be randomised into two groups. The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3 times a week for four months. The control group will be asked to maintain normal care during this period. Primary outcome measure for this study is the biochemical composition of knee cartilage measured using quantitative magnetic resonance imaging; T2 relaxation time and delayed gadolinium-enhanced magnetic resonance imaging techniques. In addition, knee cartilage morphology as regional cartilage thickness will be studied. Secondary outcomes include measures of body composition and bone traits using dual energy x-ray absorptiometry and peripheral quantitative computed tomography, pain, function using questionnaires and physical performance tests and quality of life. Measurements will be performed at baseline, after the 4-month intervention period and at one year follow up.
  
  
  CONCLUSIONS
  This randomised controlled trial will investigate the effect a progressive aquatic resistance exercise program has on the biochemical composition of cartilage in post-menopausal women with mild knee osteoarthritis. This is the first study to investigate what impact aquatic exercise has on human articular cartilage. In addition it will investigate the effect aquatic exercise has on physical function, pain, bone and body composition and quality of life. The results of this study will help optimise the prescription of aquatic exercise to persons with mild knee osteoarthritis.
  
  
  BACKGROUND
  ISRCTN65346593.
authors.affiliation: Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland. ben.waller@jyu.fi
authors.forename: Benjamin
authors.initials: B
authors.lastname: Waller
authors.forename: Matti
authors.initials: M
authors.lastname: Munukka
authors.forename: Juhani
authors.initials: J
authors.lastname: Multanen
authors.forename: Timo
authors.initials: T
authors.lastname: Rantalainen
authors.forename: Tapani
authors.initials: T
authors.lastname: Pöyhönen
authors.forename: Miika T
authors.initials: MT
authors.lastname: Nieminen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kiviranta
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Harri
authors.initials: H
authors.lastname: Selänne
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Sarianna
authors.initials: S
authors.lastname: Sipilä
authors.forename: Urho M
authors.initials: UM
authors.lastname: Kujala
authors.forename: Arja
authors.initials: A
authors.lastname: Häkkinen
authors.forename: Ari
authors.initials: A
authors.lastname: Heinonen
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D001696:Biomechanical Phenomena; D001823:Body Composition; D002358:Cartilage, Articular / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D003287:Contrast Media; D005260:Female; D005387:Finland; D006801:Humans; D007101:Immersion; D007719:Knee Joint / Q000378:metabolism* / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D010808:Physical Examination; D017698:Postmenopause; D011237:Predictive Value of Tests; D012107:Research Design; D055070:Resistance Training / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013551:Swimming Pools; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media