Can dance-based aquatic exercise improve functionality in obese women with knee osteoarthritis?

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Obesity is a costly, rapidly growing, and largely preventable disease linked with increased risk of noncommunicable disease and all-cause mortality.1,2 Whereas encouraging physical activity for overweight and obese women could potentially improve health and reduce health expenditure, around one-third of the world's population continues to be inactive.3 Moreover, in some groups, significant barriers can impede capacity for positive behavior change.
For example, health status, self-efficacy, and the physical environment are significant predictors of physical activity levels,4 and so for women with chronic health conditions, there is a tendency toward being more sedentary.
More specifically, among overweight and obese women with osteoarthritis (OA), joint damage and chronic inflammation are common and are frequently associated with decreased mobility, poor balance, and physical disability.5 Thus, interventions that can increase activity and decrease obesity levels and osteoarthritic pain are likely to have a positive impact on health-related quality of life and possibly decelerate OA progression and symptomology. One of the challenges, however, is providing an activity regime that is both acceptable within its intended target population and also decreases pain on the affected joints. From this perspective, novel approaches to exercise are necessary.
The article published by Casilda-Lopez et al6 in the current issue of Menopause addresses this important issue. This small randomized controlled trial (RCT) evaluated the effectiveness of a dance-based aquatic exercise program on functionality, cardiorespiratory capacity, postexercise heart rate, and fatigue in obese postmenopausal women with knee OA. In this study, women were randomly assigned to either a conventional (control) or dance-based aquatic exercise program three times weekly for 8 weeks. Not surprisingly, both groups showed group-time interactions, though women in the dance-based intervention group showed a more pronounced reduction in pain over time compared with the controls (P = 0.031). Results from this study are similar to other water-based interventions in which people with OA have reported significant reductions in joint pain and stiffness, and improvements in muscle strength and functional capacity after completion of the intervention.7
Whereas the intervention tested the effectiveness of an aquatic dance-based exercise, it might be the “multidimensional” nature of dance as a form of exercise (ie, a complex sensorimotor rhythmic activity that integrates physical, cognitive, and social components8 to improve physical fitness and increases social interaction and connectedness)9 that yielded greatest benefit. A number of other studies have found similar improvements associated with dance-based interventions, albeit not associated with water. For example, studies have shown that dance interventions can significantly improve both objective (resting heart rate, cardiopulmonary function, dynamic balance, and mobility) and subjective (self-reported general health and bodily pain) health indicators,10 and cognitive11 and psychosocial functioning.12
Alternatively, the perceived benefits could also be attributable (in part) to the interval training component of the program. Indeed, promising results from animal studies suggest improved bone mineral density and osteocytes lacunar occupancy of cortical subchondral bone after aerobic interval-training exercise.13 However, regardless of the exact intervention component that yielded the most success, the “multidimensional” exercise intervention developed by Casilda-Lopez et al6 was well-tolerated and acceptable to women least likely to undertake regular physical activity. Of course, further research is needed to confirm the benefits of this intervention type for this frequently sedentary population.

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