| Background and purpose: Wu Qinxi is a traditional fitness program in China.The movement of Wu Qinxi is characterized by simplicity,fluency,gentle,comfortable,flexible and combines dynamic and static training.Wu Qinxi has a requirement for the sensory motor function of the lower limbs and will not increase the joint load,due to lacking of squat for long time.The evidence suggests that Wu Qinxi has a positive effect on the rehabilitation of the knee osteoarthritis(KOA).However,the evidence lacks of the comprehensive evaluation and the exploring the therapy mechanism from the perspective of proprioception function and muscle contraction characteristics of the lower limbs.There is no report about the effect on abnormal gait of Knee Osteoarthritis(KOA)patients by Wu Qinxi exercise.And the researches ignore the therapy mechanism of proprioception function and muscle contraction characteristics of the lower limbs.The study compared and observed the comprehensive rehabilitation effect of KOA patients by Wu Qinxi exercise and strength training respectively for 12 weeks,including pain,motor function,balance function and gait,and explored the therapy mechanism of proprioception function and muscle contraction characteristics of the lower limbs.The conclusion is helpful to apply Wu Qin Xi exercise in rehabilitation of KOA scientifically and effectively and provide important theoretical basis of physical therapy to KOA.Methods: According to the KOA diagnostic criteria of the American Rheumatology Association and the imaging evidence,a total of 40 patients with knee osteoarthritis were included in the study.They were divided into three groups: the Wu Qinxi exercise group,the strength training group and the control group.The subjects in Wu Qinxi exercise group and the strength training group underwent Wu Qinxi exercise and strength training separately for 12 weeks.The subjects in control group follow the original lifestyle,exercise and medication.All subjects underwent evaluation and test before and after intervention.The evaluation and test contents are as follows: 1.Subjects received a scale survey(The Western Ontario and McMaster Universities and Visual Analogue Scale/Score).2.Motor Function Test: the completion time of 15 meter walking,10 consecutive sit-up and go up and down stairs.3.Balance FunctionTest: The data of movement range and area were collected on the three-dimensional force measuring platform when subjects closed eyes and stood on the platform.4.Knee Proprioception Test: The passive perception threshold was measured when the knee extended and flexed passively at an angular velocity of 0.4°/s.5.The Maximum Knee Strength: The maximum knee flexion and extension strength were test by Cybex when knee flex at 60°.6.The Gait Test of Walking And Go Up and Down Stairs: The kinematics and electromyography data of the lower extremity joints(hip,knee,ankle)when subjects walk on the ground and go up and down the stairs were simultaneously measured by the Qualisys Motion Capture System,the Kistler three-dimensional force platform,and the Noraxon Surface Electromyography System.The repeated measures analysis of variance was used to analyze the difference before and after the experiment and the interaction between different time groups.The one-way ANOVA was used to analyze within group before and after the experiment.Paired sample t test was used to analyze the differences between groups.The significant level was p < 0.05.Result:1.Changes in WOMAC and VAS scores:After the experiment,WOMC scores in the Wu Qinxi group(P =0.002)and thestrength group(P =0.000)were significantly lower than those before the experiment,and WOMAC scores in the Wu Qinxi group(P =0.001)and the strength group(P =0.047)were significantly lower than those in the simultaneous control group.After the experiment,the VAS scores of the Wu Qinxi group(P = 0.002)and the strength group(P = 0.003)were significantly lower,and the Wu Qinxi group was significantly lower than the control group(P = 0.003).2.Changes in motor function: After the experiment,the completion time of15 m walking(P =0.037),10 consecutive sitting(P =0.009),up stairs(P =0.001)and down stairs(P =0.002)in the Wu Qinxi group was significantly less than that before the experiment,and the completion time of up stairs(P =0.004)and down stairs(P=0.008)in the strength group was significantly less than that before the experiment.3.Changes in sensation and balance function: After the experiment,the proprioception of knee extension in the Wu Qinxi group(P= 0.005),the strengthgroup(P=0.012)and the control group(P= 0.020)were significantly improved,which may be related to the subjects' adaptation to the test method,and the proprioception of knee extension in the Wu Qinxi group(P= 0.003)was significantly reduced.After the experiment,the barycenter movement range of plantar pressure in Wu Qinxi group was significantly reduced when standing with eyes closed(P=0.011).4.Changes in maximum flexor and extensor muscle strength of the knee joint:After the experiment,the knee peak torque of the Wu Qinxi group and the power group was significantly increased(P =0.009 in the Wu Qinxi group,P =0.035 in the power group)and extension(P =0.027 in the Wu Qinxi group,P =0.038 in the power group).5.Changes in gait parameters during flat walking:(1)Changes in kinematics parameters: After the experiment,the walking speed(P =0.000 in the Wu Qinxi group,P =0.010 in the strength group),walking frequency(P =0.007 in the Wu Qinxi group,P =0.002 in the strength group)and step length(P=0.002 in the Wu Qinxi group,P =0.049 in the strength group)were significantly increased compared with that before the experiment.After the experiment,the gait cycle of the strength group decreased significantly(P =0.000),while the gait cycle of the Wu Qinxi group and the control group did not change significantly before and after the experiment.After the experiment,peripheral single support period percentagein the Wu Qinxi group(P =0.039)and the strength group(P =0.012)increased significantly,and the percentage of the single supportive period of the patients in the Wu Qinxi group was significantly higher than that in the simultaneous control group(P =0.030)and the control group(P =0.003).After the experiment,the percentage of double support period in the Wu Qinxi group(P =0.000)and the strength group(P =0.008)was significantly lower than that before the experiment.After the experiment,the percentage of support period in Wu Qinxi group decreased significantly(P =0.003)before the experiment,while the strength group(P =0.352)and the control group(P=0.766)showed no significant change.After the experiment,the minimum knee angle of the Wu Qinxi group was significantly higher than that before the experiment(P = 0.025).The maximum knee angle of the power group was significantly increased compared with that before the experiment(P = 0.018),and the knee ROM of the power group was also significantly increased compared with that before the experiment.After the experiment,the maximal ankle extension angle(P = 0.032),the maximum plantar flexion angle(P = 0.002),and the ankle joint ROM(P = 0.000)in the strengthgroup were significantly increased compared with those before the experiment,and there was no significant change in ankle joint Angle in the Wu Qinxi group and the control group.(2)Changes in kinetic parameters: After the experiment,the maximum hip flexion moment in the strength group was significantly lower than that before the experiment(P =0.005),and the significance was lower than that in simultaneous the Wu Qinxi group(P =0.000)and the control group(P =0.000).After the experiment,the maximum hip adduction moment in the Wu Qinxi group was significantly higher than that before the experiment(P =0.049),and there was no significant change in the maximum hip adduction moment in the strength group and the control group.After the experiment,the maximum hip abduction torque of the Wu Qinxi group(P =0.036)and the strength group(P =0.009)was significantly increased compared with that before the experiment,and the maximum hip abduction torque of the Wu Qinxi group was significantly higher than that of the simultaneous control group(P =0.021).After the experiment,the maximum knee extension torque of the Wu Qinxi group(P =0.009)and the strength group(P =0.006)was significantly increased compared with that before the experiment.After the experiment,the maximum ankle dorsal extension torque in the Wu Qinxi group(P =0.008)and the strength group(P =0.001)was significantly higher than that before the experiment,and the maximum ankle dorsal extension torque in the strength group was significantly higher than that in the simultaneous strength group(P =0.045).(3)Changes in emg parameters:After the experiment,the muscle synergistic contraction ratios of Femoral biceps/ Lateral femoral muscle(P=0.023)and Semitendinosus/ Medial femoral muscle(P=0.022)in the Wu Qinxi group were significantly lower than those before the experiment.There was no significant change in the ratio of muscle synergistic contraction in the other two groups.6.Changes in gait parameters when going up and down the stairs:(1)Changes in kinematic parameters: the maximum angle of the knee joint,the minimum angle of the knee joint and the range of motion of the knee joint did not show significant time effect and interaction between the three groups.(2)Changes in myoelectric parameters:Changes in the ratio of muscle synergistic contraction when going up the stairs:After the experiment,the ratio of muscle synergistic contraction of the lateral head/tibia anterior muscle(P=0.009)and the lateral femoral/femoral muscle(P=0.046)of the Wu Qinxi group was significantly higher than that before the experiment.The sex was reduced,and the ratio of muscle contraction of the lateral head/tibia anterior muscle(P=0.009)of the Wu Qinxi group was significantly lower than that of the control group.After the experiment,the ratio of synergistic contraction of lateral head of gastrocnemius muscle/anterior tibial muscle in the control group was significantly higher than that before the experiment,and significantly higher than that in the concurrent segment strength group(P=0.013).Changes in the ratio of muscle synergistic contraction when walking down stairs:there was no significant change in the ratio of muscle synergistic contraction in the three groups of subjects when walking down stairs.Conclusion:(1)12-week wuqinxi exercise can significantly alleviate the pain of stable moderate KOA patients,improve their balance and motor ability,and improve the abnormal gait of KOA patients,and the recovery effect is equivalent to strength exercise.Wuqinxi exercise can be used as a safe and effective exercise rehabilitation method for patients with knee osteoarthritis.(2)Wu Qinxi exercise to improve the abnormal gait of KOA patients,mainly inimproving the pace,stride frequency,increasing the percentage of the affected side step and the single side of the affected side,and increasing the hip adduction torque and the sacral extension torque.In addition,Wu Qinxi exercise can also improve the walking speed of KOA patients without increasing the torque of the knee.(3)The above-mentioned rehabilitation effect may increase the muscle strength of the lower limbs of KOA patients,improve the proprioception,and increase the synergistic contraction of the lateral femoral muscle/femoral muscle during walking or the upper and lower stairs.The gastrocnemius and tibialis anterior muscles contract together.Reducing changes such as changes. |
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