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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

Benjamin Waller1*, Matti Munukka1, Juhani Multanen1, Timo Rantalainen1, Tapani Pöyhönen12, Miika T Nieminen34, Ilkka Kiviranta56, Hannu Kautiainen7, Harri Selänne8, Joost Dekker9, Sarianna Sipilä110, Urho M Kujala1, Arja Häkkinen111 and Ari Heinonen1

Author Affiliations

1 Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland

2 Rehabilitation and Pain Unit, Kymenlaakso Central Hospital, Kotka, Finland

3 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland

4 Department of Radiology, University of Oulu, Oulu, Finland

5 Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

6 Department of Orthopaedics and Traumatology, Jyväskylä Central Hospital, Jyväskylä, Finland

7 Unit of Family Practice, Central Finland Central Hospital, Jyväskylä, Finland

8 LIKES Research Centre, Jyväskylä, Finland

9 Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands

10 Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland

11 Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland

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BMC Musculoskeletal Disorders 2013, 14:82  doi:10.1186/1471-2474-14-82

Published: 7 March 2013



Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis.


A minimum of 80 volunteers who meet the inclusion criteria will be recruited from the local population through newspaper advertisements. Following initial assessment volunteers will be randomised into two groups. The intervention group will participate in a progressive aquatic resistance exercise program of 1-hour duration 3 times a week for four months. The control group will be asked to maintain normal care during this period. Primary outcome measure for this study is the biochemical composition of knee cartilage measured using quantitative magnetic resonance imaging; T2 relaxation time and delayed gadolinium-enhanced magnetic resonance imaging techniques. In addition, knee cartilage morphology as regional cartilage thickness will be studied. Secondary outcomes include measures of body composition and bone traits using dual energy x-ray absorptiometry and peripheral quantitative computed tomography, pain, function using questionnaires and physical performance tests and quality of life. Measurements will be performed at baseline, after the 4-month intervention period and at one year follow up.


This randomised controlled trial will investigate the effect a progressive aquatic resistance exercise program has on the biochemical composition of cartilage in post-menopausal women with mild knee osteoarthritis. This is the first study to investigate what impact aquatic exercise has on human articular cartilage. In addition it will investigate the effect aquatic exercise has on physical function, pain, bone and body composition and quality of life. The results of this study will help optimise the prescription of aquatic exercise to persons with mild knee osteoarthritis.

Trial Registration


Osteoarthritis; Quantitative MRI; T2 relaxation time; dGEMRIC; Bone; Aquatic exercise