1. Effectiveness of Aquatic Exercise for Obese Patients with Knee Osteoarthritis: A Randomized Controlled Trial
By: Jason Erdman

2. Osteoarthritis Most common type of arthritis
Wearing away of articular cartilage at the ends of bone
Develops as joints are under pressure and repeatedly used
About 70%-80% of the population who are older than 55 years have degenerative changes in their joints

3. Relation between Obesity and OA
A chronic knee OA condition can make patients more obese as a result of their immobilization.
The incidence of knee OA has been reported to more than double with people with chronic obesity
Studies show a 10% reduction in body weight could reduce OA symptoms by 28%.

4. Advantages for Using Aquatic Exercise with Obese Population
Reduces weight bearing stress
Provides good aerobic exercise that is safe
Water resistance strengthens muscle
Temperature of the water may enhance blood circulatory function
Provides pain relief

5. Participants
Setting: Outpatient clinic at Seoul National University Bundang Hospital
Recruited Obese patients with knee osteoarthritis were who visited the rehabilitation, orthopedic surgery, and geriatric outpatient clinics at the hospital.
All participants were able to walk independently without walking devices.
Interviewed 150 subjects, 51 rejected, 10 were excluded due to medical conditions.
So 75 participants in final agreed to participate
Requirements
50 years or older (Range 52-77)
BMI over 25
Abdominal circumference is over 90 cm for men and 85 for women.
Participants were randomly allocated into 3 groups: AQE (n 26), LBE (n 25), and the control group (n 24)

6. Measurements
Height, weight, percentage of body fat (%fat), lean body mass, and BMI were measured with a bioelectrical impedance
Before assessment, all subjects refrained from exercise for 12 hours, fasted for 4 hours, and went to the bath- room within 30 minutes before exercising.
Use pain scale and surveys to evaluate program

7. The Aquatic Exercise Protocol
Designed for 40-minute duration per session, 3 times per week, for 8 weeks.
Exercise intensity was maintained at the level of more than 65% of maximal heart rate by checking subject heart rates intermittently during exercise.
Pain was closely monitored by interviews and self report forms.

8. Land Based Exercise Program
25 Participants
Focused on general conditioning with knee specific stretching and strengthening exercises.
Exercise duration was 40 minutes at each session, including 5 minutes of warm-up and 5 minutes of cool-down.
The intensity began from 40% of the 1 rep max for the beginner
Advanced classes used 60% of 1rep max was applied

9. Control Group 24 participants
Provided only the classes for home-based exercise, including the quad set exercise for strengthening of quadriceps muscles and a partial squatting along with behavioral correction of their daily activities and lifestyles

10. During the Program
In the aquatic exercise group, 1 subject dropped out because of heart problems and another because of time constraints.
In the land based exercise group, 3 subjects dropped out because of pain and discomfort.
In the control group, 4 subjects did not participate in the final evaluation because of personal reason.

11. Results Changes in pain, physical dysfunction and Quality of life
3 participants dropped out of the land based exercise group with complaints of pain and discomfort.
Aquatic Exercise group showed significant changes in pain levels compared to the land based exercise group.
BMI and Body Weight
The reductions in body weight were not significant
1.06 kg- Aquatic Exercise
0.96 kg- Land Bearing Exercise
0.47 kg- Control
BMI decreased by 0.69 in the aquatic and 0.49 in land based.

12. Opinion
Results showed that aquatic exercise had about the same effect in improving knee function as land based exercise, but aquatic exercise was more beneficial.
Program may not be of sufficient intensity to change body composition in a short period.
If you can get clients to enjoy the exercise, then success will follow.