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Steep ramp test (SRT) performance provides an estimation of preoperative aerobic fitness that is associated with postoperative outcomes. Patients with a better SRT-estimated aerobic fitness are less likely to develop postoperative complications and more likely to experience a shorter time to recovery. The SRT might be a useful and clinically accessible tool in preoperative risk assessment to identify patients at risk of postoperative morbidity and who might benefit from preoperative exercise interventions.

OBJECTIVE: To assess the efficacy of a 12-week aquatic cycling training program for improving knee pain and physical functioning in patients with knee osteoarthritis.DESIGN: Two-arm, single-blind, parallel-group randomized controlled trial.SETTINGS: OA outpatient clinic of the Maastricht University Medical Center.PARTICIPANTS: Patients (N=111, 50-70 years old) with unilateral mild to moderate knee OA.INTERVENTIONS: Participants (AC, n=55) received aquatic cycling sessions of 45 min twice-weekly. Each session combined up-right seated cycling with out-of-saddle positions and exercises for the upper and lower body. The usual care group (UC, n=47) continued with usual care and was offered twelve aquatic cycling sessions in a local swimming pool after their trial participation.MAIN OUTCOME MEASURES: The Knee Injury and Osteoarthritis Outcome Score (KOOS) on knee pain and physical function was assessed at baseline, post-intervention and 24-weeks follow-up. Multilevel (mixed regression) analysis examined the effects.RESULTS: Average attendance rate for the aquatic cycling sessions was 80%. Statistically significant differences at post-intervention and follow-up were found for knee pain (UC pretest 57.89 ±15.26, posttest 55.90 ±18.04, follow-up 57.24 ±19.16; AC pretest 56.96 ±12.96, posttest 63.55 ±15.33, follow-up 64.35 ±17.26, Estimate 8.16, SE 3.27, 95% CI 1.67 to 14.64; ES = 0.50) and physical functioning (UC pretest 66.32 ±16.28, posttest 66.80 ±19.04, follow-up 65.42 ±17.98; AC pretest 61.89 ±17.151, posttest 70.14 ±17.52, follow-up 69.00 ±16.84, Estimate 7.16, SE 3.19, 95% CI 0.83-13.49, ES = 0.43) in favour of the aquatic group.CONCLUSION: The results suggest that a 12-week aquatic cycling training programme improves self-reported knee pain and physical functioning in patients with mild to moderate knee OA compared to usual care.

OBJECTIVE: The "gold standard" treatment of intermittent claudication (IC) is supervised exercise therapy (SET). Intermittent vacuum therapy (IVT) has recently been promoted as an additional treatment of IC. During IVT, negative pressure and atmospheric pressure are alternatingly applied to the lower extremities, possibly resulting in improved circulation. The aim of this study was to determine a potential additional effect of IVT in IC patients undergoing a standardized SET program.METHODS: IC patients were recruited from three Dutch general hospitals between December 2015 and July 2017. They received a standardized SET program but were also randomly assigned to an intervention group receiving an IVT treatment (-50 mBar negative pressure) or a control group receiving a sham treatment (-5 mBar negative pressure). IVT was provided in a dedicated clinic during 12 sessions of 30 minutes during a 6-week period. The primary outcome measure was a change in maximal treadmill walking distance. Secondary outcome measures were a change in functional treadmill walking distance, 6-minute walk test, ambulatory ability, and quality of life.RESULTS: A total of 78 patients were randomized, of whom 70 were available for intention-to-treat analysis (control, n = 34; intervention, n = 36). At 6 and 12 weeks, increases in walking distance were of equal magnitude. Median (interquartile range) change in maximal treadmill walking distance during 12 weeks was +335 (205-756) meters in control patients and +250 (77-466) meters in intervention patients (P = .109), whereas functional treadmill walking distance increased +230 (135-480) meters and +188 (83-389) meters (P = .233), respectively. Mean ± standard deviation change in the 6-minute walk test was +36 ± 48 meters and +55 ± 63 meters (P = .823), respectively. Ambulatory ability and quality of life improved equally in both groups.CONCLUSIONS: IVT does not confer any additional beneficial effects in IC patients undergoing a standardized SET program.