***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis ( OA ) . METHOD Seventy-nine adults , 65 years of age or older with hip OA and at least 1 fall risk factor , were r and omly assigned to 1 of 3 groups : aquatics and education ( AE ; aquatic exercise twice a wk with once-a-wk group education ) , aquatics only ( A ; 2 wk aquatic exercise ) and control ( C ; usual activity ) . Balance , falls efficacy , dual-task function , functional performance ( chair st and s ) , and walking performance were measured pre- and postintervention or control period . RESULTS There was a significant improvement in fall risk factors ( full-factorial MANCOVA , baseline values as covariates ; p = .038 ) ; AE improved in falls efficacy compared with C and in functional performance compared with A and C. CONCLUSION The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis STUDY OBJECTIVES To underst and reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee . DESIGN A qualitative study , nested within a r and omised controlled trial , examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis . In the intervention arm , participants undertook a series of simple exercises and repositioning of the kneecap using tape . In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions , guided by a topic schedule , to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy . Interviews were audiotaped , fully transcribed and analysed thematically according to the method of constant comparison . A model explaining factors influencing compliance was developed . SETTING Patients were interviewed at home . The study was nested within a pragmatic r and omised controlled trial . PARTICIPANTS Twenty participants in the intervention arm of the r and omised trial were interviewed three months after they had completed the physiotherapy programme . Eight were interviewed again one year later . MAIN RESULTS Initial compliance was high because of loyalty to the physiotherapist . Reasoning underpinning continued compliance was more complex , involving willingness and ability to accommo date exercises within everyday life , the perceived severity of symptoms , attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis . A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms . CONCLUSIONS Non-compliance with physiotherapy , as with drug therapies , is common . From the patient 's perspective , decisions about whether or not to comply are rational but often can not be predicted by therapists or research ers . Ultimately , this study suggests that health professionals need to underst and reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness OBJECTIVES The study objectives were to evaluate the efficacy of integrating hatha yoga therapy with therapeutic exercises for osteoarthritis ( OA ) of the knee joints . DESIGN This was a prospect i ve , r and omized , active controlled trial . Two hundred and fifty ( 250 ) participants who had OA knees and who were between 35 and 80 years ( yoga 59.56±9.54 ) and ( control 59.42±10.66 ) from the outpatient department of Ebnezar Orthopedic Center , Bengaluru , were r and omly assigned to receive hatha yoga therapy or therapeutic exercises after transcutaneous electrical stimulation and ultrasound treatment ( 20 minutes per day ) . Both of the groups practice d supervised interventions ( 40 minutes per day ) for 3 months . One hundred and eighteen ( 118 ) ( yoga ) and 117 ( control ) subjects were available for the final analysis . RESULTS There were significant differences within ( Wilcoxon 's , p<0.001 ) and between the groups ( Mann-Whitney U , p<0.001 ) on all the variables , with better improvements in the yoga than the control groups . Walking pain in the yoga ( 37.3 % , 64.9 % ) and control ( 24.9 % , 42 % ) , knee disability in the yoga ( 59.7 % , 83 % ) and control ( 32.7 % , 53.6 % ) , range of knee flexion in yoga ( 12.7 % , 26.5 % right , 13.5 % , 28 % left ) and control ( 6.9 % , 13.3 % right , 5.6 % , 11.5 % left ) , joint tenderness in yoga ( 52.3 % , 86.1 % ) and control ( 28 % , 57.1 % ) , swelling in yoga ( 55.4 % , 85.9 % ) and control ( 32.1 % , 60 % ) , crepitus in yoga ( 44.0 % , 79.9 % ) and control ( 27.0 % , 47.8 % ) and walking time in yoga ( 26.6 % , 52.8 % ) and control ( 9.3 % , 21.6 % ) , all improved more in the yoga than the control groups on the 15th and 90th day , respectively . CONCLUSIONS An integrated approach of hatha yoga therapy is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in improving walking pain , range of knee flexion , walking time , tenderness , swelling , crepitus , and knee disability in patients with OA knees We investigated the effects of a multi-station proprioceptive exercise program on functional capacity , perceived knee pain , and sensoriomotor function . Twenty-two patients ( aged 41 - 75 years ) with grade 2 - 3 bilateral knee osteoarthrosis were r and omly assigned to two groups : treatment ( TR ; n = 12 ) and non-treatment ( NONTR ; n = 10 ) . TR performed 11 different balance/coordination and proprioception exercises , twice a week for 6 weeks . Functional capacity and perceived knee pain during rest and physical activity was measured . Also knee position sense , kinaesthesia , postural control , isometric and isokinetic knee strength ( at 60 , 120 and 180 ° ·s(-1 ) ) measures were taken at baseline and after 6 weeks of training . There was no significant difference in any of the tested variables between TR and NONTR before the intervention period . In TR perceived knee pain during daily activities and functional tests was lessened following the exercise program ( p < 0.05 ) . Perceived knee pain was also lower in TR vs. NONTR after training ( p < 0.05 ) . The time for rising from a chair , stair climbing and descending improved in TR ( p < 0.05 ) and these values were faster compared with NONTR after training ( p < 0.05 ) . Joint position sense ( degrees ) for active and passive tests and for weight bearing tests improved in TR ( p < 0.05 ) and the values were lower compared with NONTR after training ( p < 0.05 ) . Postural control ( ' eyes closed ' ) also improved for single leg and t and em tests in TR ( p < 0.01 ) and these values were higher compared with NONTR after training . The isometric quadriceps strength of TR improved ( p < 0.05 ) but the values were not significantly different compared with NONTR after training . There was no change in isokinetic strength for TR and NONTR after the training period . The results suggest that using a multi-station proprioceptive exercise program it is possible to improve postural control , functional capacity and decrease perceived knee pain in patients with bilateral knee osteoarthrosis . Key PointsIt is possible to improve postural control , functional capacity and decrease perceived knee pain in patients with bilateral knee osteoarthrosis with a pure proprioceptive/ balance exercise program used in the present study .The exercise regime used in the present study was as effective as previous studies , but of much shorter duration and utilized unsophisticated , inexpensive equipment which is available in most physiotherapy departments . Therefore , the incorporation of this exercise program into clinical practice is readily feasible OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Background Studies on exercise in knee osteoarthritis ( OA ) have focused on elderly subjects . Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis . The aim was to test the effects of a short-term , high-intensity exercise program on self-reported pain , function and quality of life . Methods Patients aged 36–65 , with OA grade III ( Kellgren & Lawrence ) were recruited . They had been referred for radiographic examination due to knee pain and had no history of major knee injury . They were r and omized to a twice weekly supervised one hour exercise intervention for six weeks , or to a non-intervention control group . Exercise was performed at ≥ 60 % of maximum heart rate ( HR max ) . The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Follow-up occurred at 6 weeks and 6 months . Results Sixty-one subjects ( mean age 56 ( SD 6 ) , 51 % women , mean BMI 29.5 ( SD  
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From the patients ' perspectives , ways to improve the delivery of exercise interventions included : provide better information and advice about the safety and value of exercise ; provide exercise tailored to individual 's preferences , abilities and needs ; challenge inappropriate health beliefs and provide better support .
Participation in exercise programmes may slightly improve physical function , depression and pain .
It may slightly improve self-efficacy and social function , although there is probably little or no difference in anxiety .
Providing reassurance and clear advice about the value of exercise in controlling symptoms , and opportunities to participate in exercise programmes that people regard as enjoyable and relevant , may encourage greater exercise participation , which brings a range of health benefits to a large population of people