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Table 1 Description of exercises included in the intervention

From: Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial

Warm-up (10-15 minutes)

Strength training (35 minutes)

Cool down (10 minutes)

1. Standing hip flexion/extension

1. Standing hip flexion/extension (Figure 3): Standing side on to wall and stand on leg furthest away from wall. Swing leg nearest wall forwards and backwards as fast as possible using full range of motion. Keep knee of moving leg in full extension and ankle in dorsiflexion. Maintain spinal neutral at all times.

3-5 minutes of walking and supported cycling against wall

2. Standing hip abduction/Abduction

2. Hip adduction/abduction (Figure 2): Stand on right leg with knee fully extended. Keeping knee straight and ankle in dorsiflexion swing left leg from side to side as fast as possible using full range of motion. Left leg crosses over in front of right leg. Particular attention is paid to maintaining a neutral pelvic and spinal position.

Stretches, 30 seconds stretch for each side.

3. Seated bilateral knee flexion/extension.

3. Seated knee flexion/extension (Figure 5): Sitting on chair keeping back of legs fixed against seat, alternately flex and extend both knees as fast as possible using full range of motion.

1. Hip flexors (Iliopsoas)

4. Calf raises on edge of step (weeks 1-8 double leg, weeks 9-16 single leg)

4. Standing knee flexion/extension (Figure 4): Standing side on to wall and transfer weight on to leg furthest away from wall. Lift leg nearest wall straight up in front stopping just before any stretch sensation is felt in the posterior aspect of thigh. Keeping thigh still, flex and extend knee as fast as possible using full range of motion.

2. Gluteus maximus

5. Balance beam (EWAC, Netherlands) walking forwards and backwards (weeks 1-6 without arms, weeks 6-12 carry tray with ball on, 13-16 same eyes closed)

5. Kickback (reverse lunge) (Figure 6): Standing on edge of step board so that moving leg can be swung down next to it. Starting position is with supporting leg in full extend and other hip and knee is in flexion up near wall. Leg is explosively straightened down towards bottom of pool and then kicked backwards with leg straight as far as possible. During this movement supporting leg is flexed but plantar aspect of foot is kept firmly pressed against step.

3. Quadriceps

6. Standing abdominals (either pushing and pull frisbee, trunk rotation with frisbee or rowing with aquatic rolling pin), weeks 1-8 double leg stance, week 9-16 single leg).

 

4. Hamstrings

7. Abdominal with feet in frisbee against wall (figure of 8, circles 30 second each direction)

5. Iliotibial band

8. Hurdles (EWAC Netherlands), weeks 1-6 stepping over hurdles, weeks 6-12 double leg jumps forwards and backwards over 30 cm hurdle, 13-16 single leg jumps forwards over 30 cm high hurdle)

6. Adductors

9. Weeks 1-6 scissor jumps, weeks 6-12 jumping over 30 cm hurdle sideways, weeks, 13-16 single leg sideways jumping over 30 cm hurdle.

7. Gastrocnemius

10. Dynamic balance ½ of the group jog/run around other ½ of group who are trying to maintain balance.