Effect of quadriceps strengthening exercises alone and in combination with Baduanjin qigong on older adults with knee osteoarthritis: a quasi-experimental study

Effect of quadriceps strengthening exercises alone and in combination with Baduanjin qigong on older adults with knee osteoarthritis: a quasi-experimental study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Effect of quadriceps strengthening exercises alone and in combination with Baduanjin qigong on older adults with knee osteoarthritis: a quasi-experimental study fenglan wang, Xiaoli Zhang, Xiao Tong, Min Zhang, Fengmei Xing, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-70038/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Mar, 2021 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 12 You are reading this latest preprint version Abstract Background Exercise is recommended as a core treatment for individuals with KOA. However, the optimal exercise program to promote long-term compliance for KOA patients is not clear. The aim of this study is to compare the effects of the combination exercise program (quadriceps strengthening exercises (QSE) plus Baduanjin qigong) versus QSE alone on older adults with knee osteoarthritis (KOA). Methods A two-arm, quasi-experimental trial with repeated measurements was used. As a cluster randomized trial, participants from one community center were assigned to combination exercise group while participants from the other center were assigned to QSE group. We assessed pain intensity, physical function, self-efficacy, and HRQoL with standardized instruments at baseline, 3 and 6 months. Results 87 participants with KOA who aged above 60 completed the study. Over the 6 months, There were significant time by group interaction effects on pain intensity (F = 44.419, p < 0.001), physical function (F = 46.904, p < 0.001) and self-efficacy (F = 49.754, p < 0.001), as well as in the physical component summary (F = 15.205, p < 0.001) and mental component summary of SF-12 (F = 19.205, p < 0.001), with the combination exercise group exhibiting significantly greater improvements in all outcomes than QSE group. Conclusions Combination exercise treatment is more effective than QSE for relieving pain, increasing physical functioning, and improving self-efficacy, and quality of life in community-dwelling KOA older adults. Also, it could promote long-term compliance for KOA community patients. Trial registration Chinese Clinical Trails Registry number ChiCTR2000033387 (retrospectively registered). Registered 30 May 2020 Nursing Surgery knee osteoarthritis Baduanjin qigong quadriceps strengthening exercises Figures Figure 1 Figure 2 Figure 3 Full Text Supplementary Files Additionalfile3CONSORT2010Checklist.doc Additionalfile2Availabilityofdataandmaterials.xlsx Additionalfile1.pdf Cite Share Download PDF Status: Published Journal Publication published 29 Mar, 2021 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Major revision 18 Nov, 2020 Review # 3 received at journal 17 Nov, 2020 Reviewer # 3 agreed at journal 24 Oct, 2020 Review # 2 received at journal 09 Oct, 2020 Review # 1 received at journal 09 Oct, 2020 Reviewer # 2 agreed at journal 21 Sep, 2020 Reviewers invited by journal 20 Sep, 2020 Reviewer # 1 agreed at journal 20 Sep, 2020 Editor assigned by journal 17 Sep, 2020 Submission checks completed at journal 15 Sep, 2020 Editor invited by journal 14 Sep, 2020 First submitted to journal 30 Aug, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-70038","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":2386323,"identity":"b7bac147-1ba2-4366-8d6f-870aa7a9f7db","order_by":0,"name":"fenglan wang","email":"","orcid":"https://orcid.org/0000-0001-5339-0901","institution":"North China University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"fenglan","middleName":"","lastName":"wang","suffix":""},{"id":2386324,"identity":"b58ac995-b374-447d-8665-f4603be2d557","order_by":1,"name":"Xiaoli Zhang","email":"","orcid":"","institution":"North China University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Zhang","suffix":""},{"id":2386325,"identity":"c49a054e-a952-493c-ab67-5d4c9470e47e","order_by":2,"name":"Xiao Tong","email":"","orcid":"","institution":"The Second Hospital of Tangshan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Tong","suffix":""},{"id":2386326,"identity":"d982bb20-b022-4a02-8889-8f78338b6b83","order_by":3,"name":"Min Zhang","email":"","orcid":"","institution":"North China University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Zhang","suffix":""},{"id":2386327,"identity":"4c63eb2c-269a-4a16-800b-249eb3089312","order_by":4,"name":"Fengmei Xing","email":"","orcid":"","institution":"North China University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fengmei","middleName":"","lastName":"Xing","suffix":""},{"id":2386328,"identity":"5ae23e61-0802-4bc3-8fd6-9be7595124d3","order_by":5,"name":"Kun Yang","email":"","orcid":"","institution":"North China University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"Yang","suffix":""},{"id":2386329,"identity":"c0fa08d0-34ab-464f-8185-4567c5e94285","order_by":6,"name":"Nana Jiao","email":"","orcid":"","institution":"North China University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nana","middleName":"","lastName":"Jiao","suffix":""},{"id":2386330,"identity":"b6ba555a-50e6-44b0-a14a-e955a3ebc956","order_by":7,"name":"Zhiguang Duan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYDCCAwzsHz5U2EB5bMRpYWOccSaNRC3MvG2HSdDCd/74tQc8Z87bG1w7Y8DwoewwA//sBvxaJA+cKTeQqLidOHN2jgHjjHOHGSTuHMCvxeBgT4KEwZnbCfzSOQZgFxpIJBDQcpgnQSKx7Zw9G0jLX6K0HGM/JnGw7QBjP0gLIzFaJM/wMBs2nEkG+iWt4GDPuXQeiRsEtABD7OHjPxV29ga3kzc++FFmLcc/g4AWBgYeAzjzAIhLSD0QsD8gQtEoGAWjYBSMaAAAL6BH1WwFdpwAAAAASUVORK5CYII=","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Zhiguang","middleName":"","lastName":"Duan","suffix":""}],"badges":[],"createdAt":"2020-09-01 11:07:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-70038/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-70038/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-021-04179-8","type":"published","date":"2021-03-29T19:06:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":2456904,"identity":"c6240a66-fcad-410e-b276-5320dd8286f1","added_by":"auto","created_at":"2020-09-17 15:58:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153163,"visible":true,"origin":"","legend":"Flowchart of the study participants. QSE: quadriceps strengthening exercise; BDJ: baduanjin qigong; QSE plus BDJ: a combination of quadriceps strengthening exercise and baduanjin qigong.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-70038/v1/Figure1.jpg"},{"id":2456905,"identity":"553d93f7-c49a-4950-ad95-98bc17654150","added_by":"auto","created_at":"2020-09-17 15:58:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82315,"visible":true,"origin":"","legend":"Trends of pain intensity for the QSE and QSE plus BDJ group participants at the 3 time points of the study. WOMAC: Western Ontario and McMaster Universities osteoarthritis index; QSE: quadriceps strengthening exercise; BDJ: baduanjin qigong; QSE plus BDJ: a combination of quadriceps strengthening exercise and baduanjin qigong; MFU: month of follow-up.","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-70038/v1/Figure2.jpg"},{"id":2456906,"identity":"184692e0-5732-4c25-9ce3-3a536aebbc55","added_by":"auto","created_at":"2020-09-17 15:58:53","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":88716,"visible":true,"origin":"","legend":"Trends of physical function for the QSE and QSE plus BDJ group participants at the 3 time points of the study. 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However, the optimal exercise program to promote long-term compliance for KOA patients is not clear. The aim of this study is to compare the effects of the combination exercise program (quadriceps strengthening exercises (QSE) plus Baduanjin qigong)\u0026nbsp;versus QSE alone on older adults with knee osteoarthritis (KOA). \u003c/p\u003e\u003cp\u003eMethods\u003c/p\u003e\u003cp\u003eA two-arm, quasi-experimental trial with repeated measurements was used. As a cluster randomized trial, participants from one community center were assigned to combination exercise group while participants from the other center were assigned to QSE group. We assessed pain intensity, physical function, self-efficacy, and HRQoL with standardized instruments at baseline, 3 and 6 months. \u003c/p\u003e\u003cp\u003eResults\u003c/p\u003e\u003cp\u003e87 participants with KOA who aged above 60 completed the study. Over the 6 months, There were significant time by group interaction effects on pain intensity (F = 44.419, p \u0026lt; 0.001), physical function (F = 46.904, p \u0026lt; 0.001) and self-efficacy (F = 49.754, p \u0026lt; 0.001), as well as in the physical component summary (F = 15.205, p \u0026lt; 0.001) and mental component summary of SF-12 (F = 19.205, p \u0026lt; 0.001), with the combination exercise group exhibiting significantly greater improvements in all outcomes than QSE group. \u003c/p\u003e\u003cp\u003eConclusions\u003c/p\u003e\u003cp\u003eCombination exercise treatment is more effective than QSE for relieving pain, increasing physical functioning, and improving self-efficacy, and quality of life in community-dwelling KOA older adults. Also, it could promote long-term compliance for KOA community patients.\u003c/p\u003e\u003cp\u003eTrial registration\u003c/p\u003e\u003cp\u003eChinese Clinical Trails Registry number ChiCTR2000033387 (retrospectively registered). Registered 30 May 2020\u003c/p\u003e","manuscriptTitle":"Effect of quadriceps strengthening exercises alone and in combination with Baduanjin qigong on older adults with knee osteoarthritis: a quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-17 15:58:51","doi":"10.21203/rs.3.rs-70038/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-11-19T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-18T00:00:00+00:00","index":3,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nDear editor in chief\nI am pleased to review the manuscript entitled: Effect of quadriceps strengthening exercises alone and in combination with Baduanjin qigong on older adults with knee osteoarthritis: a quasi-experimental study. Firstly, congratulation to authors to perform such interesting original paper. OA is considered the most common form of arthritis. It is a slowly progressive, disabling joint disorder that significantly reduces quality of life. Exercise plays an important role in the treatment of knee OA. This paper aims to compare the effects of the combination exercise program versus QSE alone on older adults with knee OA. They concluded that combination exercise treatment is more effective than QSE for relieving pain, increasing physical functioning, and improving self-efficacy, and quality of life in community-dwelling knee OA older adults. I have a few suggestion to improve the paper. (1) Abstract: Change Background to Objective. (2) Is there any other effect among groups? (3) Language should be modified by a native speakers. (4) Evidence level should be noted in your paper. (5) Conclusion should added one sentence:\" Considering the small sample size of our study, the conclusion should be treated with caution\".* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **'I declare that I have no competing interests' below. If your reply is yes to any, please give details below.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-24T12:00:00+00:00","index":3,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-09T12:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\n# The authors should present reasons why the inclusion criteria considered 60 years as old people and not 65 years (commonly used internationally).\n\n# Which clinical criteria were used for diagnosed KOA?\n\n# Please, I recommend that the authors reinforce the clinical applicability of this study in the introduction section.\n\n# I would like to see you expand upon what additional research needs to be done in this area, as well as expand upon your study implications. It would be nice to give some direction or further explain what your study determined in this section, so as to make your paper more significant and part of an ever expanding aspect of the academic field.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-10-09T12:00:00+00:00","index":1,"fulltext":"Recommendation: Reject\nForm responses:\n---\n\nComments to Author:\n---\n\n1) Abstract. Spell out any acronym when first use it in your narrative. \"KOA,\" first line of the abstract.\n2) The trial registration in the Chinese Clinical Trial Registry was not accessible. Make sure that you provide the correct webpage and registration ID.\n3) On line 22, the authors stated that one of the advantages of exercise interventions is \"low-cost.\" However, in line 38, they stated that \"patients withdrew from exercise interventions due to time and economic pressure.\" Those statements are contradictory and need to be clarified. Also, if patients with KOA are dropping from exercise programs due to economic burden, how does the proposed exercise program (quadriceps strengthening exercises plus Baduanjin qigong) would improve compliance? \n4) Page 4, line 13. Qigong is not an aerobic exercise. The intervention applied in this study is not in line with the Ottawa guidelines that recommend strengthening in combination with aerobic exercise to manage KOA.\n5) Inclusion/exclusion criteria. Potential subjects participating in a regular Baduanjin qigong program were not included. What is the definition of regular? What if they were participating in a different modality of Qigong or Tai Chi, were they included?\n6) Description of the quadriceps strengthening exercise should be included in the manuscript's body and not only in the \"additional file.\" \n7) Lack of information about the Baduanjin qigong protocol.\n8) The entire manuscript needs to be revised for grammar and typos. Some sentences are hard to understand.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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