Original article
A Randomized Controlled Trial to Investigate the Effects of Water-Based Exercise to Improve Falls Risk and Physical Function in Older Adults With Lower-Extremity Osteoarthritis

https://doi.org/10.1016/j.apmr.2011.08.004Get rights and content

Abstract

Hale LA, Waters D, Herbison P. A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis.

Objective

To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis (OA).

Design

Randomized controlled trial.

Setting

Community.

Participants

Persons (N=39; mean±SD age, 74±6y; 26 women) with mild to moderate OA and at risk for falling met study criteria, were measured at baseline, and were randomly assigned to the intervention (n=23) and control groups (n=16).

Interventions

Water-based program (12wk, twice weekly; intervention group) or a time-matched computer training program (control group).

Main Outcome Measure

The primary outcome was the short-form Physiological Profile Assessment (PPA). Secondary outcomes included the Step Test, Timed Up and Go Test, Western Ontario and McMaster Universities OA Index (Likert 3.0 version), Arthritis Impact Measurement Scales 2, and Activity-specific Balance Confidence Scale.

Results

No statistically significant between-group differences were found for any outcome measured (n=35; 4 lost to follow-up). Within-group analysis indicated that Step Test results improved significantly in both groups (mean change: control group, left leg, 2.07; 95% confidence interval, 3.19–.95; P=.002; intervention group, 2.14; 95% confidence interval, 3.20–1.08; P=.000). Two PPA item scores (reaction time, contrast sensitivity) improved significantly (86.83; 95% confidence interval, 9.86–163.79; P=.03; 1.43; 95% confidence interval, 2.35–.50; P=.005, respectively) in the control group, resulting in a lower falls risk score.

Conclusions

Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class. Our study is, to our knowledge, the first to compare water-based exercise in this population with a control group that attended a time-dose–equivalent seated community-based activity. Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation.

Section snippets

Design

This was an observer-blinded RCT. No changes were made to the trial design after trial start.

Recruitment and Participants

Recruitment began in January 2009, and baseline testing and intervention occurred in 2 groups in March and June 2009. Participants responded to public advertisements in local newspapers, radio, and television and posters and flyers placed in local community centers, general practitioners' (GPs') and physiotherapists' offices, libraries, churches, and organizations catering to elders. Volunteers

Results

Of 114 volunteers for the study, 52 individuals were eligible and consented to participate. Before baseline testing, 13 individuals withdrew. Figure 1 shows the flow of participants through the study.

Baseline characteristics of the 39 participants assessed at baseline and randomly assigned to the experimental and control groups are listed in table 2. Average ± SD age of participants was 75±1.3 years (range, 70.5–77.9y) and 74% were women. Most participants were using a number of prescribed

Discussion

A 12-week twice-weekly water-based exercise program that specifically targeted balance in older adults with OA did not result in a significant difference in falls risk compared with attending a community-based computer skills training program. Although participants subjectively told us of their perceived improvements in balance and our observation of the experimental group's performance in the water over the course of the program gave testimony to this, these changes were not statistically

Conclusions

A 12-week twice-weekly water-based exercise class did not reduce falls risk compared with attending a time-dose–equivalent computer skills training class. Similar studies have reported significant improvements after water-based exercise, but control groups in these studies did not receive sedentary control activities. Significant improvements were found for both groups postintervention for the Step Test and we suggested that this improvement may be the result of participants getting out of the

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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