Efficacy of Exercise in the Sitting Position Compared with Exercise in the Standing Position in Obese Patients with Knee Osteoarthritis

Tirza Zainuddin Tamin; Clements Clements

Authors

Tirza Zainuddin Tamin Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Clements Clements Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

knee osteoarthritis, exercise therapy, obesity, weight-bearing exercise program

Abstract

Background: Knee osteoarthritis (OA) is a degenerative condition that causes pain, swelling, and stiffness, affecting a person’s ability to move freely. Non-weight-bearing therapeutic exercise programs provide better pain reduction and improve joint function compared with conventional exercise programs. This study compared the effectiveness of therapeutic exercises in sitting versus standing positions in reducing pain, improving knee function, and enhancing quality of life in obese patients with OA. Methods: Fifty-four obese women aged 50–80 years were randomly assigned to one of two exercise program groups, either sitting or standing. Members of each group participated in a 12-week intervention consisting of aerobics, hip stretching and strengthening, and balance exercises. Sessions lasted 45 minutes, three times per week, increasing by 30 minutes every four weeks. Pain was assessed using the Numerical Rating Scale, knee function was measured with the Knee Injury and Osteoarthritis Outcome Score, and quality of life was assessed with the 12-Item Short Form Survey. Measurements were taken at baseline and every four weeks during the intervention. Results: When compared with the standing position group, the sitting position group showed significantly less pain and better knee function as determined by NRS and KOOS, as well as better physical quality of life (p<0.05). In contrast, the standing position group had a better mental quality of life. Conclusion: Therapeutic exercises in a sitting position are more effective in reducing pain, improving knee function, and enhancing physical quality of life in OA. However, standing exercises contribute more to mental well-being.

References

World Health Organization. Osteoarthritis. July 14, 2023. (cited November 6, 2024). Available from: https://www.who.int/news- room/fact-sheets/detail/osteoarthritis

Hsu, H, Siwiec RM. Knee Osteoarthritis. StatPearls - NCBI Bookshelf. June 26, 2023. https://www.ncbi.nlm.nih.gov/boo ks/NBK507884 (accessed 6 November 2024).

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039–49. https://doi.org/10.1002/art.17802 90816.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: A Cochrane systematic review. Br J Sports Med. 2015;49(24):1554–7. https://doi.org/10.1136/bjsports- 2015-095424.

Perez-Huerta BD, Diaz-Pulido, B, Pecos-Martin D, Beckwee D, Lluch-Girbes E, Fernandez-Matias R, et al. Effectiveness of a Program Combining Strengthening, Stretching, and Aerobic Training Exercises in a Standing Versus a Sitting Position in Overweight Subjects with Knee Osteoarthritis: A Randomized Controlled Trial. Journal of Clinical Medicine, 9(12), MDPI AG, Dec. 2020, p. 4113.

Lin DH, Lin CH, Lin YF, Jan, M.H. Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther. 2009 Jun;39(6):450–7. https://doi.org/10.2519/jospt.2009.2923.

Phatama, KY, Aziz A, Bimadi MH, Oktafandi IGNAA, Cendikiawan F, Mustamsir E. Knee Injury and Osteoarthritis Outcome Score: Validity and Reliability of an Indonesian Version. Ochsner Journal, 21(1), Ochsner Journal, 2021, pp. 63–67. https://doi.org/10.31486/toj.20.00 88.

Jurado-Castro JM, Muñoz-López, M, Ledesma AST, Ranchal-Sánchez A. Effectiveness of Exercise in Patients with Overweight or Obesity Suffering from Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(17).

Maqbool M, Fekadu G, Jiang X, Bekele F, Tolossa T, Turi E, et al. An update on clinical prospects and management of osteoarthritis. Ann Med Surg (Lond). 2021 Nov 19; 72:103077. https://doi.org/10.1016/j.amsu.20 21.103077.

Runhaar J, Luijsterburg P, Dekker J, Bierma-Zeinstra SM. Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2015 Jul;23(7):1071–82. https://doi.org/10.1016/j.joca.201 4.12.027.

Khan S, Islam S, Ahmed A, Khan R, Tasneem S, Shahid G. Evaluating the impact of weight-bearing and non- weight-bearing exercises on pain and physical function in obese knee osteoarthritic patients: a randomized controlled trial. Allied Med Res J. 2023;1(2):16. Available from: https://doi.org/10.59564/amrj/01.0 2/005

Bennell KL, Nelligan RK, Kimp AJ, et al. What type of exercise is most effective for people with knee osteoarthritis and comorbid obesity? The TARGET randomized controlled trial. Osteoarthritis and Cartilage. Elsevier BV. 2020;28(6):755–65. https://doi. org/10.1016/j.joca.202 0.02.838.

Creasy SA, Rogers RJ, Byard TD, Kowalsky RJ, Jakicic JM. Energy expenditure during acute periods of sitting, standing, and walking. J Phys Act Health. 2016 Jun;13(6):573–8. https://doi.org/10.1123/jpah.2015- 0419.

Saeidifard F, Medina-Inojosa JR, Supervia M, et al. Differences of energy expenditure while sitting versus standing: A systematic review and meta-analysis. Eur J Prev Cardiol. 2018 Mar;25(5):522–38.