The efficacy of swimming and cycling training in individuals with osteoarthritis : a randomized controlled clinical trial
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Osteoarthritis (OA) is the number one cause of disability among older adults and is associated with cardiovascular disease (CVD) due, at least in part, to sedentary lifestyle in OA. Symptoms of OA such as joint pain act as a significant barrier for middle-aged and older adults attempting to perform physical activity. Thus, swimming can be an ideal form of exercise for patients with OA as it is non-weight bearing and would not aggravate symptoms of OA. However, there is no information available regarding the beneficial effects of regular swimming exercise involving patients with OA. Accordingly, the general aim of the present study was to determine the effects of a 12-week swimming exercise intervention on functional capacity, pain, vascular function, and markers of inflammation in middle-aged and older adults with OA. Using a controlled, randomized study design, forty-eight sedentary middle-aged and older adults with OA underwent 12 weeks of either swimming or cycling exercise training. Cycling exercise was used as a land-based exercise comparison group. All exercise sessions were closely supervised and consisted of 45 minutes/session 3 days/week at 60-70% heart rate reserve. In Study 1, we assessed changes in functional outcomes and pain. Participants in both swimming and cycling exercise training groups demonstrated significant increases in distance covered during the 6-min walk test, as well as maximal grip strength and isokinetic knee extensor and flexor strength. We observed decreases in body mass, visceral adiposity, and waist and hip circumference in both exercise training groups. Additionally, there were reductions in pain and stiffness accompanied by increased physical function, as determined by the WOMAC index, in both groups. It should be noted, there was no advantage in the swimming or cycling group in any of these measurements. In Study 2, we investigated improvements in vascular function and markers of inflammation. We observed significant reductions in central artery stiffness following both exercise interventions, and the arterial destiffening effects were observed all across various measures of arterial stiffness. A significant improvement in endothelium-dependent vasodilation, as determined by brachial flow-mediated dilation, was observed after the swimming, but not after the cycling exercise training. Furthermore, both exercise training groups significantly decreased levels of the inflammatory marker, IL-6. Taken together, results suggest that swimming exercise was effective in improving physical function and vascular function as well as in reducing pain in middle-aged and older adults with OA. These findings are of paramount clinical importance to patients with OA, as swimming may be a desirable mode of exercise, but is often viewed as inferior to land-based exercise in regards to maximizing health benefits gained from exercise.