Application of quantitative and progressive exercise rehabilitation to patients with osteoarthritis of the knee

Osteoarthritis (OA) is one of the most prevalent and disabling diseases in the elderly, a rapidly growing segment of the population. OA is typically treated with a combination of drugs and inactivity, with total joint arthroplasty as the final treatment alternative. This paper reviews the potential of a non-surgical intervention for patients with OA, namely exercise rehabilitation. Several types of exercise rehabilitation are considered: home exercise (HE), physical therapy (PT), cycle exercise (CE) and a new program, quantitative progressive exercise rehabilitation (QPER). The HE program demonstrated improvements in some physiological and functional variables; however, these improvements were minimal. PT had a greater effect than HE on quadriceps and hamstring muscle strength and endurance and functional performance; however, PT had no effect on muscle contraction speed. The QPER program improved motor unit activation, quadriceps and hamstring muscle strength and endurance, contraction speed and all aspects of functional performance. In addition, QPER, although not aerobic, improved cardiorespiratory fitness and maximal workrate of VO2. This program significantly reduced difficulty, dependency and pain (during rest, exercise and at night). It would appear that the therapy of choice would be QPER since it reduces symptoms, improves joint integrity and may lead to delays in arthroplasty. These changes could improve the quality of life of patients with OA, as well as other diseases, and reduce medical costs.