Do Obese Patients With Primary Knee Osteoarthritis Benefit From a Single Bout of Moderate Intensity Aerobic Exercise?
Do Obese Patients With Primary Knee Osteoarthritis Benefit From a Single Bout of Moderate Intensity Aerobic Exercise?
Background: Obesity and degenerative joint disease are typically concomitant . Each are in
 the course of aerobic focus and excited inflammatory response. Exercise is taken into account
 a considerable treatment in rehabilitation of each conditions. nevertheless most of
 literature reported the good thing about regular exercise, whereas there's dearth regarding
 the consequence of base hit low to centrist usage session .

 Objective:Hence, this report aimed to analyze the attainable effects of a single bout of
 moderate excercise in obese patients with KOA.

 Methods:Thirty four rotund OA untrained semantic role and thirty age and sex matched healthy
 controls were registered during this sketch . OA patients were allotted to single session of
 low to moderate exercise on treadmill whereas controls remained unexercised. Perceived pain,
 GR activity, IL-6 , CRP, fasting blood glucose and lipid profile were assessed at baseline ,
 once exercise and 24h after. Meanwhile, WOMAC score determined at baseline and once 24h.
Study population:

 This is an observational study a cohort of sedentary Egyptian patients included thirty four
 obese patients role diagnosed with primary human knee joint OA according to the criteria of
 the American College of Rheumatology (ACR)( 8).were selected from those attending the
 outpatient clinics of Rheumatology and Rehabilitation Department , Mansoura University (28
 females and 6 males; mean age, 46.94 ± 10.84 years; trunk mass index, 40.91 ± 10.09 kg/m2).
 In addition, 30 healthy volunteers with no clinical and radiological evidence of OA(22
 females and8 males; mean age,50.7 ±10.5 ; BMI 24.3±1.3)participated in the discipline .

 Inclusion criteria: knee OA with obesity; sedentary with no previous education ; ability to
 understand and follow commands; and ability to walk independently.

 Exclusion criteria: Medical conditions contraindicating moderate aerobic exercising (as
 determined through prescreening questions, i.e., cardiac or coronary artery disease as
 ischemic cardiomyopathy , chronic lung disease, asthma, uncontrolled hypertension), inability
 to exercise via treadmill(i.e. no neuromuscular or lower extremity conditions or any other
 medical contraindication that could prevent them from floor walking as upset affecting
 movement of the pelvic arch or pace , story of previous hip or knee operating room
 ,periarticular fractures, or lower limb injuries).History of recent reefer transmission or
 acute joint lighting .History of recent joint injection (steroid, hyaluronic acid , etc.)
 within 6 calendar week of study. Ingestion of antioxidant supplementation and the use of
 psychotropic agents.

 Participants underwent bilateral AP standing x ray to verify the presence and degree of human
 knee OA. X-rays were marked exploitation the Kellgren and Lawrence (K/L) scale for knee OA
 severity(9).Subjects with picture taking knee OA of KL grade ≥2 in a minimum of one knee were
 listed. The grading of the worst affected knee in every patient was used for knowledge
 analysis.

 Physical examinations including age and body mass index (BMI) were obtained at the same
 visits at which radiographs were obtained. Western Ontario and McMaster Universities
 Arthritis Index (WOMAC) scores of the OA patients were collected (10).

 Treadmill Training Protocol

 Each eligible participant in the patients group was then prospectively assigned to undergo
 exercise session of full-body-free weight treadmill training. Once the participants were
 prepped, they performed stretching for 5 min and slow walking for 3 min as a warm-up exercise
 before starting the training. Stretch was carried out similarly to all the subjects to
 quadriceps femoris and the hamstring. In the warm-up time period , it was enforced for 3 min
 at the speed of1 km/h. Then patients began the walking trials and walked at 1 to 1.34 m/s on
 an electric car treadmill (JACO fitness: JACO-212C).

 Exercise intensity

 For the purpose of this study, Metabolic Equivalents (METs) and Rate of Perceived Exertion
 (RPE) were used as guidelines to determine exercise intensity. Moderate aerobic exercise has
 been objectively defined as activity that generates energy expenditure of 3.0 to 6.0 (METs)
 (11).

 To determine the intensity, time and frequency of exercise, it was set at low to moderate,
 that is between 40% and 60% of the maximum heart rate, from 12 to 14 rating of RPE. In
 addition, each subject was shown the 15 point Borg Rating of Perceived Exertion scale and
 instructed in its use. The RPE scale was mounted on the wall in front of the treadmill and
 easily visible to the subjects. Exercise instructions and measurements of associated
 Metabolic Equivalents (METs) were determined based upon previous studies which determined
 that walking on a level surface at 3.0 MPH equates to 3.3 METs and walking at 4.5 MPH
 generates 6.3 METs(12).

 Participants walked at a pace of 2.5 to 3.0 MPH on a treadmill with zero incline for 30 min
 and they were instructed to walk at a pace that neither caused pain nor increased symptoms
 (13).

 To minimize pain that may occur due to treadmill exercise, 5 min rest were allowed after 15
 min of exercise. In the control group, the subjects remained at rest.

 The present study was conducted in agreement with the guidelines of the Declaration of
 Helsinki. Written informed consent was received from every patient and healthy subject before
 participating in the study. This study was approved by the Institutional Research Board of
 the Faculty of Medicine, Mansoura University code R.18.04.137

 Laboratory assays:

 Blood samples were drawn before and once exercise (within 0.5 h once exercise,and at 24 h).
 All organic chemistry measurements were performed on frozen plasma samples obtained by
 activity of freshly drawn blood (3000 × g for 20minutes at 4∘C) and consequent storage at
 -70∘C. Blood macromolecule profiles, together with total cholesterol (TC), HDL cholesterol
 (HDL-C), calculated LDL cholesterol(LDL-C), and triglycerides (TG) concentrations were
 determined by protein assays., further as abstinence blood sugar level.

 IL-6, CRP Serum concentrations of IL-6 were determined using sandwich high sensitivity ELISA
 kit for quantitative detection of human IL-6 according to manufacturer's protocol (Boster
 Immunoleader by Boster Biological Technology Co. Inc.). Detection of serum CRP was performed
 by Solid Phase Sandwich ELISA according to manufacturer's instructions (Quantikine Human CRP
 Immunoassay, R&D systems)

 Glutathione reductase assay:

 Spectrophotometric determination of GR activity in the serum was measured as described by
 Calberg and Mannervic (14) using commercially available Glutathione Reductase Assay Kit(Sigma
 chemical company, St Louis, Missouri, USA). Glutathione reductase catalyzes the reduction of
 GSSG by oxidizing NADPH to NADP+. The decrease in absorbance was measured at 340.
Inclusion Criteria:

 -  : knee OA with obesity; sedentary with no previous education ; ability to understand
 and follow commands; and ability to walk independently.

 Exclusion Criteria:

 -  Medical conditions contraindicating moderate aerobic exercising (as determined through
 prescreening questions, i.e., cardiac or coronary artery disease as ischemic
 cardiomyopathy , chronic lung disease, asthma, uncontrolled hypertension), inability
 to exercise via treadmill(i.e. no neuromuscular or lower extremity conditions or any
 other medical contraindication that could prevent them from floor walking as upset
 affecting movement of the pelvic arch or pace , story of previous hip or knee
 operating room ,periarticular fractures, or lower limb injuries).History of recent
 reefer transmission or acute joint lighting .History of recent joint injection
 (steroid, hyaluronic acid , etc.) within 6 calendar week of study. Ingestion of
 antioxidant supplementation and the use of psychotropic agents.