Volume 23, Issue 4 (Oct - Nov 2019)                   2019, 23(4): 308-319 | Back to browse issues page

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Attari E. Evaluation Factors Affecting on Falling of Elderly Women With Knee Arthritis Following Tai Chi ‎Exercises and Glucosamine. Journal of Inflammatory Diseases. 2019; 23 (4) :308-319
URL: http://journal.qums.ac.ir/article-1-2808-en.html
Department of Physical Education, Faculty of Management and Accounting, Qazvin Branch, Islamic Azad University, Qazvin, Iran. , elhamattari58@yahoo.com
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1. Introduction
As the age increases, the body becomes more susceptible to diseases related to muscle weakness and factors related to joint stability. Knee osteoarthritis (OA) is one of the most common musculoskeletal problems in the elderly that has a devastating effect on articular cartilage, synovial membrane, articular capsule and ligaments. It reduces joint proprioception, disrupts neuromuscular coordination, cause muscle weakness and decreased range of motion and flexibility, and negatively affect activities of daily living and increase the falling rate in these patients [2]. OA has no definite cure. Use of analgesics and glucosamine sulfate supplements, intra-articular injection, surgery and use of brace and auxiliaries and conservative interventions (movement therapy). American Academy of Orthopaedic Surgeons and American College of Rheumatology have proposed conservative intervention as main strategy for controlling knee OA [8]. The aim of this study was to evaluate some factors of physical fitness affecting the fall of elderly women with knee OA following Tai Chi exercise and glucosamine sulfate supplementation.
2. Materials and methods
This is a quasi-experimental study with pretest-posttest design (a registered clinical trial with code IRCT20180314039092N1). After informing in Qazvin city, 75 elderly women with knee OA were selected randomly. After confirmation of a physician for OA of bilateral knee with stage 2 and 3 according to Kellgren-Lawrence Grading System, they were divided into three groups of control, exercise and supplement each consisted of 25 samples [22]. Inclusion criteria were: age >60 years, not taking medication for knee OA, having no regular exercise (2 days or more per week), and obtaining score >24 at Mini-Mental State Exam [11]. Having neurological disease affecting balance; having diabetes, severe respiratory and articular disease; deformity of lower limbs, use of walking aids, dizziness and use of drugs that affect balance were exclusion criteria [20, 21].
The exercise group performed Tai Chi exercise for 3 months, 3 sessions per week under the supervision of a specialist and researcher. Tai Chi exercise included 10 min warm-up, performing 12 main movements of Tai Chi exercise in 8 repetitions, and then 10 min cooling down. The supplement group received 900 mg glucosamine sulfate (Health Burst Co., USA) 3 times weekly for 3 months with a physician’s prescription. The control group received no intervention. Dynamic (functional) balance was measured by Berg balance scale. This test evaluates the patient’s ability to balance based on 14 components that are most commonly used in daily life. The reliability of each components has been reported 0.98 [23]. 
Lower extremity strength was assessed using a 30 second Chair Stand test, a valid measure whose reliability for elderly women has been reported 0.92 [24]. Sit and Reach test was used to measure flexibility, which measures the degree of leaning forward and reach the box with both hands by using a centrifugal ruler in cm. The reported reliability for this test is 0.91 [25]. To compare the pretest and posttest data, paired t-test was used, and multivariate ANOVA and Tukey’s range test was used to compare the scores of three study groups at a significance level of p<0.05. Data were analyzed in SPSS v. 17 software.
3. Results
There was no significant difference between the three groups in terms of age, height, weight and body mass index. Paired t-test showed that only exercise group had significant improvement in dynamic balance, lower extremity strength and flexibility before and after the intervention (p=0.001). Results of multivariate ANOVA showed a significant difference between the three groups after intervention in balance (P=0.001; F=12.19), lower extremity strength (P=0.006; F= 5.65) and flexibility (P=0.04; F=3.45). Table 1 presents the results of Tukey’s range test.

4. Conclusion
The results of the present study showed that Tai Chi exercise can significantly improve the balance, lower extremity strength and flexibility of the elderly women with knee OA, while glucosamine sulfate supplementation had no significant effect on any of these variables. This is consistent with the results of Ariayi et al. who showed improvement in balance after Tai Chi exercise in the elderly with knee OA, and those of Zhou et al. who reported improvements in the strength of the lower limb of the elderly following the Tai Chi exercise, but is against the results of Lund et al. and Song et al. [27, 30, 32, 36].
The positive effects of exercise include increased training-induced neurocognitive adaptations such as more efficient use of neural units, reorganization in the somatosensory cortex, increased efficiency and strength of synaptic connections, improved neuromuscular control and motor unit synchronization, reduced neuronal inhibitory reflexes, decreased neural pathway resistance to impulse transmission and improvement and facilitation of data transfer within each of the senses [29].
Ethical Considerations
Compliance with ethical guidelines

The protocol of this study was approved by the Ethics Committee at the University of Tehran with ID “IR.UT.SPORT.REC.1396031” and clinical trail code IRCT.20180314039092.
This article is from the PhD. thesis of the author, Elham Attar, Department of Physical Education, Faculty of Management and Accounting, Qazvin Branch, Islamic Azad University, Qazvin.
Authors' contributions
All authors contributed in preparing this article.
Conflicts of interest
This article has no conflict of interest.

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Type of Study: Research | Subject: physical education

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