A randomized, controlled, clinical trial of a yoga-based exercise intervention for knee osteoarthritis / Background: Knee osteoarthritis is a chronic disease involving the breakdown of joint tissues resulting in pain and disability. Exercise provides equivalent pain relief to medication, improves physical functioning, and ameliorates co-morbidities. However, certain forms of exercise can potentially overload the joint and exacerbate symptoms; the optimal type is unknown. We developed a yoga-based exercise intervention designed for knee osteoarthritis by incorporating postures that minimize a mechanical loading variable implicated in disease progression. Purpose: The objective was to compare the efficacy of this biomechanically-tailored yoga program as treatment for knee osteoarthritis with the current “gold standard” of physical therapy, and a no-exercise attention control group. Methods: A single-blinded, 12-week, 3-arm, parallel randomized control trial was conducted. Participants (women 50 years or over, with clinical knee osteoarthritis; n=31) were stratified by disease severity and randomized to receive biomechanical yoga exercise (YE; n=10), traditional exercise (TE; n=11), or no-exercise (NE; n=10). The primary outcome measure was pain; secondary outcomes included patient-reported physical function and mobility performance; and tertiary outcomes included muscular strength, quality-of-life, and symptoms of depression. Results: The YE and TE groups demonstrated statistically and clinically significant within-group improvements in pain, physical function, and mobility performance (p<0.017), while the NE group did not. The YE group reported greater improvements in pain compared to the NE group (p=0.003). The YE group also demonstrated greater improvements in physical function compared to NE (p=0.010). There were no significant between-group differences in mobility performance, strength, quality-of-life, or depression (p>0.05). Conclusion: Yoga appears as an efficacious and well-tolerated conservative treatment option for women with knee osteoarthritis. The yoga intervention yielded comparable, and in some cases possibly greater improvements in the major burdening symptoms of the disease compared to traditional physical therapy. Future investigations with larger samples are warranted to establish effectiveness and possibly superiority to traditional exercise. / Thesis / Master of Science (MSc) / Osteoarthritis of the knee is a debilitating joint disease and a leading cause of disability. Treatment often involves medication to control pain and surgery when drugs fail. Exercise is a conservative approach to improve symptoms and quality of life. Some forms of exercise however can overload the knee and possibly worsen the disease. We have developed a yoga-inspired exercise regimen specifically for knee osteoarthritis that minimizes damaging mechanical loads. To test this program, women with knee osteoarthritis were randomly assigned to receive either 12 weeks of yoga, traditional physical therapy, or no-exercise. Before and after the intervention, pain, physical function, and mobility were measured. The yoga and traditional exercise groups demonstrated improvements in pain, physical function, and mobility; while the no-exercise group did not. In some aspects, yoga even outperformed traditional exercise. These findings suggest yoga is as effective as traditional exercise, and potentially more so, in treating knee osteoarthritis.

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The primary purposes of this study were to determine biomarker concentration levels at pre exercise and in response to an acute running bout in participants with an acute knee injury history (AKIH) in comparison to healthy control participants. The secondary purposes were to determine if self-perceived pre-exercise functional outcome score differences existed between participants with AKIH in comparison to healthy control participants, and whether these measures correlated with biomarker concentration changes after an acute running bout. Twenty-two (10 females, 12 males) college-aged individuals who were physically active participated in the study (11 with AKIH, 11 without AKIH). A two-group pre-test/post-test study design was utilized. The exercise bout consisted of running at 2.2 m * s -1 for 30 min on a motorized treadmill. Statistical significance was defined as p ≤ 0.05. The serum biomarker concentrations (i.e., COMP, IL-1ß, MMP-13, CTX-II, CPII, and CTX-II/CPII ratio) assessed in this study were not found to be significantly different based on AKIH status pre exercise and after 30 min of running. AKIH participants did have significantly lower pre-exercise functional scores compared to their matched healthy controls. Additionally, pre-exercise functional scores (i.e., KOOS quality of life and current Tegner activity) showed moderate negative correlations to IL-1ß and CTX-II/CPII ratio biomarker changes post exercise, respectively. The findings of this study indicate that an acute bout of moderate-intensity running is tolerated in a high-risk AKIH population and does not adversely affect knee biomarker metabolism. However, these findings should be interpreted with caution as it is yet to be determined if a higher exercise dose and/or intensity, as well as other varied types of exercise elicit adverse biomarker response within this population or if these findings are replicable in other populations (e.g., older aged). AKIH participants reported overall lower functional scores than healthy control participants, which may be indicative of impending structural or biomarker changes. Questions still remain about short- and long-term interventions post AKIH since there are many potential confounding factors that affect OA progression. Post-AKIH pathophysiology is complex and while there are unique variables that may accelerate OA onset, there may be an interaction effect of these variables that accelerate and propagate OA, and this still needs further investigation. / Kinesiology

The goal of this thesis is to investigate the possibility of using vibration analysis to detect and assess a very common joint disease known as osteoarthritis (OA). For this purpose, patients with various levels of OA, healthy to severe OA, were recruited and MRI and vibration recordings were made on both knees. MRI images were analyzed by a radiologist and different symptoms related to osteoarthritis in the knee were scored for each observation. Vibration signals of the patients' knees were recorded using 5 accelerometers placed at different locations of the knee. This thesis divides into two major sections; the first section deals with design of an apparatus (a function specific brace and the electronic hardware) for acquiring and recording vibration data from a patient's knee. The second section deals with the analysis of the recorded data using a combination of signal processing techniques (Fourier and wavelet transforms) and multivariate statistical methods (principal component (PCA) and partial least square (PLS)). The brace designed and built for the purpose of this research has several unique properties not found in commercial knee braces. It provides a robust and secure base for attachment of the sensors to the knee and shows very good adaptation to the dynamics of the knee during motion. In the analysis section we show that combining signal processing and multivariate statistical techniques (such as PCA and PLS) provides strong tools for analysis of the data. The result of our analysis shows that there is a strong correlation between vibration analysis and some of the symptoms of osteoarthritis such as cartilage degeneration and formation of osteophytes. We conclude that vibration signals of the knee joint (crepitus) during flexion/extension cycle of the knee, when it is under stress, can be a good indicator of the general severity of OA in patients. / Thesis / Master of Science (MS)

Introduction: OA of the knee and/or hip is a common joint disease where the first line treatment is physical activity and exercise, weight management and patient education. Previous research has shown that digital aids and product can be used as support for exercise. VITALA is a new digital app under development. Aims: The purpose of this study was to evaluate the effectiveness of VITALA regarding joint pain, opinion about the knee and/or hip and lower extremity function in people with OA of the knee and/or hip and whether signs of altered pain processing affected the effect.                                                   Methods: In a prospective cohort study, 17 participants with clinically diagnosed OA of the knee and/or hip exercised with the support of VITALA for three months. Outcome measures were Numerical Pain Rating Scale, Knee Injury/Hip disability and Osteoarthritis Outcome Score and 30 Second Chair Stand Test. Hierarchical regression analyses were used to see if the effect on the outcome measures was affected by pressure pain thresholds, neuropathic pain symptoms or central nervous symptoms.                 Results: No significant effect was seen on any of the outcome measures. Central Sensitization Inventory did as an individual variable in a regression model with age and gender have a significant effect on change in Knee Injury/Hip disability and Osteoarthritis Outcome Score. Apart from this, no pain type affected the results. Conclusion: Three months of exercising with the VITALA app did not influence the outcome measures. The pain characteristic variables did generally not affect the results. This specific app requires further development and evaluation before it can be recommended to people with OA / Introduktion: Artros i höft och/eller knä är vanliga ledsjukdomar där första ledets behandling är fysiskt aktivitet och träning, viktkontroll och utbildning. Tidigare forskning har visat att digitala tjänster och produkter kan användas som stöd för träning. VITALA är en ny digital tjänst under utveckling. Syfte: Syftet med denna studie var att utvärdera effektiviteten av VITALA vad gäller ledsmärta, åsikt om knät/höften, och funktion i nedre extremitet samt huruvida tecken på förändrad smärtmodulering påverkade effekten. Metod: I en prospektiv kohortstudie tränade 17 deltagare med klinisk artros med stöd av VITALA i tre månader. Utfallsmått var Numerical Pain Rating Scale, Knee Injury/Hip disability and Osteoarthritis Outcome Score och 30 Second Chair Stand Test. Hierarkiska regressionsanalyser användes för att mäta om effekten på varje utfallsmått påverkades av smärttrösklar, neuropatiska smärtsymtom eller centralnervösa symtom.                  Resultat: Ingen signifikant effekt sågs avseende något av utfallsmåtten. Central Sensitization Inventory hade som individuell variabel i en regressionsmodell med ålder och kön en signifikant effekt på förändring av Knee Injury/Hip disability and Osteoarthritis Outcome Score. I övrigt påverkade inte smärttyp resultaten. Slutsats: Tre månader av träning med appen VITALA påverkade inte utfallsmåtten. Smärttypsvariablerna verkade generellt inte påverka resultaten. Denna app kräver fortsatt utveckling och utvärdering innan den kan rekommenderas till personer med artros.

Tribology is the science of interacting surfaces in relative motion. It is specifically concerned with the friction, wear and lubrication of these surfaces. Although tribology has conventionally been associated with the surface interaction of mechanical systems, concepts of tribology have also been important in the study of biological systems. Biotribology is one of the newest fields to emerge in the discipline of tribology. It can be described as the study of friction, wear and lubrication of biological systems, mainly synovial joints such as the human hip and knee. Osteoarthritis (OA) is partially characterized by the loss of articular cartilage from the contacting surface of the articulating bones in synovial joints. Although it has been studied extensively, the exact pathways and pathogenesis of OA have yet to be determined. Several factors have been cited as possible contributors to the condition. These factors can primarily be grouped into two categories of mechanical or biochemical abnormalities. Research in biotribology enables the examination of both the mechanical and biochemical factors involved in joint lubrication and OA. This research has focussed on the mechanisms of normal joint lubrication, as well as the possible connections between biotribology and osteoarthritis. Particular emphasis is placed on the effects of biochemical changes and environment on cartilage wear and damage. Studies were carried out using a test device developed to study the tribological properties of articular cartilage, in vitro. A cartilage-on-cartilage test configuration was used with bovine articular cartilage and a cartilage-on-stainless steel configuration used with lapine articular cartilage. Articulating surfaces were put in sliding contact under a normal load. Natural and biochemically modified environments were created to simulate possible normal and pathologic in vivo conditions. Wear and friction of the articular cartilage were measured and related to biochemical environments which are suspected in clinical cases of OA. Quantitative measurement of cartilage wear was achieved through hydroxyproline assay of the post-test lubricants. Surface and subsurface damage were also examined through the use of scanning electron microscopy and histological staining techniques. The results of four separate studies demonstrated that: (1) exposure of bovine cartilage to collagenase-3, an enzyme suspected in the cartilage degeneration seen in OA, significantly increased cartilage wear (p = 0.001); (2) lapine cartilage with surgically induced OA exhibited higher coefficients of friction, but no significant increase in wear over normal cartilage from the same animal; (3) the addition of white blood cell lysate, comparable to what would be seen in mild joint inflammation, to synovial fluid significantly increased cartilage wear over normal synovial fluid (p = 0.002); (4) the removal of "boundary lubricating" surface-active phospholipids (SAPLs) from normal synovial fluid had no significant effect on cartilage wear. These results demonstrate that biochemical changes in the cartilage, as well as the synovial fluid, can lead to increased wear of and damage to the articular cartilage surface. How these changes may occur in living systems remains to be determined. The use of the tribological test device developed and various analytical techniques has made it possible to quantitatively evaluate the effects of biochemical changes and environment on the wear and damage of articular cartilage. These studies have demonstrated that research in biotribology has the potential to make significant contributions to the current knowledge not only of normal joint lubrication but of joint pathology as well. / Ph. D.

Osteoarthritis (OA) is a debilitating disease of joints that afflicts horses of all ages and breeds and can result in lameness, suboptimal performance, and decreased quality of life. The pro-inflammatory cytokine interleukin-1 (IL-1) has been associated with the initiation and pathogenesis of joint disease. In part, this occurs by induction of proteases and oxidative pathways that contribute to the degradation of structural components of the articular cartilage extracellular matrix. Elucidating the complex macromolecular and molecular effects of IL-1 on articular tissues may further our understanding of the roles of IL-1 and inflammation in OA pathobiology. Full-length gene sequences encoding three recombinant equine interleukin-1 proteins (EqIL-1a, EqIL-1b, and EqIL-1 receptor antagonist), were previously cloned and expressed in-vitro. The objectives of this dissertation were to 1) establish EqIL-1 induced experimental models of equine OA, and 2) to investigate specific IL-1-induced immuno-inflammatory responses. Effects of EqIL-1 on articular cartilage explant proteoglycan metabolism and synthesis of a downstream inflammatory product, prostaglandin E2, established culturing conditions and furthered the rationale to use EqIL-1 in the in-vitro modeling of early joint disease. A customized cDNA array was used to profile changes in mRNA levels resulting from EqIL-1 treatments of cultured articular cartilage chondrocytes. EqIL-1a induced elevated mRNA levels corresponding to six genes after 1 hour relative to media control chondrocytes (p<0.05). EqIL-1b increased transcript levels of seven genes after 6 hours (p<0.0004); 102 additional transcripts were elevated > 2-fold over controls. A subset of the array-generated data was verified using optimized reverse transcriptase-PCR amplification. Results of principal component analysis indicate co-regulation of EqIL-1 induced transcript levels to relate to chondrocyte differentiation and cell-cycle processes. Subtractive hybridization-PCR identified 148 differentially expressed cDNAs in synovium resulting from a 6-hour intra-articular EqIL-1b injection. Combined results demonstrate the potent bioactivity of our equine IL-1 proteins and support the argument for crucial roles of IL-1 in pro-inflammatory processes and cytokine imbalances underlying early OA pathogenesis. These results add to the current knowledge of IL-1 modulated transcription that may precede ECM catabolic processes characteristic of OA. The culture systems, assays, and techniques for gene expression analysis may be useful for future studies attempting to elucidate macromolecular and transcriptional events underlying inflammatory-associated joint disease processes in horses. Reported information may further efforts toward improved diagnostic and preventive strategies and development of anti-IL-1 directed therapies. / Ph. D.