flexion ROM in the experimental group increased
over time from baseline to the 12th week, whereas
the control group remained the same as baseline
measurements. The results reveal the beneficial
effect of the exercise program on knee flexion ROM.
In the experimental group, ESs of knee flexion ROM
in both knees improved from a small to medium
level at the completion of the intervention. In both
groups, changes in knee extension ROM indicated
a little difference from a normal value41 and showed
no statistically significant. One possible reason was
that all eligible participants had mild to moderate
severity of knee symptoms. Therefore, their knee
joints would have little or no deformity.
This study indicated that the experimental group
had improved SEE, M-SEV, and some physical
performance components during the 12-week
exercise program. Community participation is needed
in a community-based intervention. With an introduction
to the elderly club at the potential settings,
key persons and community members had discussed
with the researcher about the objective, process, and
expected outcomes of the study. Key persons in each
study setting had helped to introduce the objective
of the study, find eligible participants, and motivate
eligible participants who had decided not to
participate at the first time. These key persons,
especially in the experimental setting, influenced
the possibility of adherence to exercise of study
participants during the study. Thus, key persons in
the community have potential to motivate study
participants to maintain their exercise behavior and
include exercise in their healthy lifestyle.
Limitations of this study include the small
sample size, the specific gender and elderly club
members, non-randomization, and non-blinded
outcome measures. In addition, non-significant
difference in most study variables are needed to
re-studied. An increase in sample size and random
sampling may elucidate this phenomenon. In spite
of these limitations, this study has several strengths.
Firstly it has demonstrated the efficacy of a
community-based exercise program and secondly
it has provided important baseline data to inform
future intervention studies. Further studies also
need to be undertaken including women who are
not members of clubs, who are still working in
communities, and who are completely non-exercising.
Conclusion and Recommendations
These results indicate some benefits of the community-based
exercise program for Thai women with
osteoarthritis of the knee in enhancing self-efficacy
for exercise, decreasing severity of knee symptoms,
and improving some physical performance without
exacerbation of the disease. This study provides a
preliminary support that the community-based
exercise program including stationary cycling may
be used as an exercise modality for people with
osteoarthritis of the knee in communities to enhance
self-efficacy for exercise, decrease severity of
knee symptoms, and increase physical function.
Recommendations for further studies on larger group
of women in community other than elderly club
members, completely non-exercise women, and long
term follow-ups were addressed to detect significant
differences and changes of SEE, OEE, M-SEV, and
physical performance in women with osteoarthritis
of the knee.
Acknowledgement
The researcher expresses her sincere appreciation
to all community members and community health
nurses in study settings for their involvement and
support to the study; and her gratitude to the Division
of Sport Medicine, Department of Orthopedic Surgery,
Faculty of Medicine, Siriraj Hospital, Mahidol
University for non-profit providing the concentric
isokinetic muscle strength testing. This study was
part of the doctoral program supported by a
scholarship from the Commission of Higher
Education, Ministry of Education and was partly
funded by the Thai Health Promotion Foundation.
flexion ROM in the experimental group increasedover time from baseline to the 12th week, whereasthe control group remained the same as baselinemeasurements. The results reveal the beneficialeffect of the exercise program on knee flexion ROM.In the experimental group, ESs of knee flexion ROMin both knees improved from a small to mediumlevel at the completion of the intervention. In bothgroups, changes in knee extension ROM indicateda little difference from a normal value41 and showedno statistically significant. One possible reason wasthat all eligible participants had mild to moderateseverity of knee symptoms. Therefore, their kneejoints would have little or no deformity.This study indicated that the experimental grouphad improved SEE, M-SEV, and some physicalperformance components during the 12-weekexercise program. Community participation is neededin a community-based intervention. With an introductionto the elderly club at the potential settings,key persons and community members had discussedwith the researcher about the objective, process, andexpected outcomes of the study. Key persons in eachstudy setting had helped to introduce the objectiveof the study, find eligible participants, and motivateeligible participants who had decided not toparticipate at the first time. These key persons,especially in the experimental setting, influencedthe possibility of adherence to exercise of studyparticipants during the study. Thus, key persons inthe community have potential to motivate studyparticipants to maintain their exercise behavior andinclude exercise in their healthy lifestyle.Limitations of this study include the smallsample size, the specific gender and elderly clubmembers, non-randomization, and non-blindedoutcome measures. In addition, non-significantdifference in most study variables are needed tore-studied. An increase in sample size and randomsampling may elucidate this phenomenon. In spiteof these limitations, this study has several strengths.Firstly it has demonstrated the efficacy of acommunity-based exercise program and secondlyit has provided important baseline data to informfuture intervention studies. Further studies alsoneed to be undertaken including women who arenot members of clubs, who are still working incommunities, and who are completely non-exercising.Conclusion and RecommendationsThese results indicate some benefits of the community-basedexercise program for Thai women withosteoarthritis of the knee in enhancing self-efficacyfor exercise, decreasing severity of knee symptoms,and improving some physical performance withoutexacerbation of the disease. This study provides apreliminary support that the community-basedexercise program including stationary cycling maybe used as an exercise modality for people withosteoarthritis of the knee in communities to enhanceself-efficacy for exercise, decrease severity ofknee symptoms, and increase physical function.Recommendations for further studies on larger groupof women in community other than elderly clubmembers, completely non-exercise women, and longterm follow-ups were addressed to detect significantdifferences and changes of SEE, OEE, M-SEV, andphysical performance in women with osteoarthritisof the knee.AcknowledgementThe researcher expresses her sincere appreciationto all community members and community healthnurses in study settings for their involvement andsupport to the study; and her gratitude to the Divisionof Sport Medicine, Department of Orthopedic Surgery,Faculty of Medicine, Siriraj Hospital, MahidolUniversity for non-profit providing the concentricisokinetic muscle strength testing. This study waspart of the doctoral program supported by ascholarship from the Commission of HigherEducation, Ministry of Education and was partlyfunded by the Thai Health Promotion Foundation.
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