Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis

<p>Knee Osteoarthritis (KOA) causes pain, stiffness and muscular weakness which</p><p>results in reduced activities of daily living (ADL). This study aims to compare the</p><p>effect of aquatic exercise (AqE) and Thera-band exerci...

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Main Author: Kogilavani S.Krishnan
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Language:eng
Published: 2023
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Online Access:https://ir.upsi.edu.my/detailsg.php?det=9851
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institution Universiti Pendidikan Sultan Idris
collection UPSI Digital Repository
language eng
topic GV Recreation Leisure
spellingShingle GV Recreation Leisure
Kogilavani S.Krishnan
Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
description <p>Knee Osteoarthritis (KOA) causes pain, stiffness and muscular weakness which</p><p>results in reduced activities of daily living (ADL). This study aims to compare the</p><p>effect of aquatic exercise (AqE) and Thera-band exercises (TbE) on pain intensity,</p><p>endurance, and quality of life (QoL) among obese people with KOA. In this crosssectional</p><p>study, a total of forty-five obese participants (n = 45; male = 22, female =</p><p>23) with KOA (BMI 27.5 kg.m-2) were purposively recruited and randomly</p><p>assigned into three groups; Aquatic exercise group (AqG), Thera-band exercise group</p><p>(TbG), and the control group (CG). For the analysis of results, using the Mixed</p><p>ANOVA method, it revealed that there is a significant effect between AqE and TbE</p><p>on pain intensity (F: (2/42) = 34.18, p < 0.001), endurance (F:(2/42) = 11.425, p <</p><p>0.001) and quality of life (F:(2/42) = 32.148, p < 0.001) with control group. Even</p><p>though there was not a significant difference between AqG and TbG in pain intensity</p><p>(p=0.896), and endurance (p=0.072), there was significant difference in QoL between</p><p>both intervention groups (p=0.022). In addition, the results revealed a significant</p><p>improvement among AqG compared to CG in pain intensity (p=0.001), endurance</p><p>(p=0.046) and QoL(p=0.000). The MANCOVA results displayed a significant</p><p>interaction of group time effect on all sub-domains of QoL. In addition, pairwise</p><p>comparisons between groups among QoL sub-domains revealed that there was a</p><p>significant difference between AqG and TbG in all dimensions of QoL (pain,</p><p>symptom, ADL, sport/recreation and knee related QoL. To conclude, progressive AqE</p><p>and TbE can alternatively be suggested for improvement of pain intensity, endurance,</p><p>and quality of life among people with KOA while the effect size of AqE program was</p><p>slightly greater in both variables.</p>
format thesis
qualification_name
qualification_level Master's degree
author Kogilavani S.Krishnan
author_facet Kogilavani S.Krishnan
author_sort Kogilavani S.Krishnan
title Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
title_short Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
title_full Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
title_fullStr Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
title_full_unstemmed Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
title_sort comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis
granting_institution Universiti Pendidikan Sultan Idris
granting_department Fakulti Sains Sukan dan Kejurulatihan
publishDate 2023
url https://ir.upsi.edu.my/detailsg.php?det=9851
_version_ 1794025763796680704
spelling oai:ir.upsi.edu.my:98512024-02-26 Comparison of aquatic and thera-band exercise on pain, endurance and quality of life among obese people with knee osteoarthritis 2023 Kogilavani S.Krishnan GV Recreation Leisure <p>Knee Osteoarthritis (KOA) causes pain, stiffness and muscular weakness which</p><p>results in reduced activities of daily living (ADL). This study aims to compare the</p><p>effect of aquatic exercise (AqE) and Thera-band exercises (TbE) on pain intensity,</p><p>endurance, and quality of life (QoL) among obese people with KOA. In this crosssectional</p><p>study, a total of forty-five obese participants (n = 45; male = 22, female =</p><p>23) with KOA (BMI 27.5 kg.m-2) were purposively recruited and randomly</p><p>assigned into three groups; Aquatic exercise group (AqG), Thera-band exercise group</p><p>(TbG), and the control group (CG). For the analysis of results, using the Mixed</p><p>ANOVA method, it revealed that there is a significant effect between AqE and TbE</p><p>on pain intensity (F: (2/42) = 34.18, p < 0.001), endurance (F:(2/42) = 11.425, p <</p><p>0.001) and quality of life (F:(2/42) = 32.148, p < 0.001) with control group. Even</p><p>though there was not a significant difference between AqG and TbG in pain intensity</p><p>(p=0.896), and endurance (p=0.072), there was significant difference in QoL between</p><p>both intervention groups (p=0.022). In addition, the results revealed a significant</p><p>improvement among AqG compared to CG in pain intensity (p=0.001), endurance</p><p>(p=0.046) and QoL(p=0.000). The MANCOVA results displayed a significant</p><p>interaction of group time effect on all sub-domains of QoL. In addition, pairwise</p><p>comparisons between groups among QoL sub-domains revealed that there was a</p><p>significant difference between AqG and TbG in all dimensions of QoL (pain,</p><p>symptom, ADL, sport/recreation and knee related QoL. To conclude, progressive AqE</p><p>and TbE can alternatively be suggested for improvement of pain intensity, endurance,</p><p>and quality of life among people with KOA while the effect size of AqE program was</p><p>slightly greater in both variables.</p> 2023 thesis https://ir.upsi.edu.my/detailsg.php?det=9851 https://ir.upsi.edu.my/detailsg.php?det=9851 text eng closedAccess Masters Universiti Pendidikan Sultan Idris Fakulti Sains Sukan dan Kejurulatihan <p>Abadi, F. H., Elumalai, G., Sankaraval, M., & Ramli, F. A. B. M. (2017). Effects of aqua-aerobic exercise on the cardiovascular fitness and weight loss among obese students. International journal of physiotherapy, 4(5), 278-283.</p><p></p><p>Abadi, F. H., Choo, L. A., Sankaravel, M., & Mondam, S. (2018). A Comparative Study of Water and Land Based Exercises Training Program on Stability and Range of Motion. 7, 6872.</p><p></p><p>Abadi, F. H., Sankaravel, M., Zainuddin, F. F., Elumalai, G., & Razli, A. I. (2019). The effect of AE program on low-back pain disability in obese women. 15(6), 855860.</p><p></p><p>Abadi, F. H., Sankaravel, M., Zainuddin, F. F., Elumalai, G., Choo, L. A., & Sattari, H. (2020). A perspective on water properties and AE for older adults. International Journal of Aging Health and Movement, 2(2), 1-10.</p><p></p><p>Ackerman, J. M., Goesling, J., & Krishna, A. (2020). Pain scales as placebos: Can pain scales change reported pain across measurements?. Journal of Experimental Social Psychology, 88, 103961.</p><p></p><p>Adar, S., Dndar, ., Demirdal, . S., Ulasli, A. M., Toktas, H., & Solak, . (2017). The effect of AE on spasticity, quality of life, and motor function in cerebral palsy. Turkish Journal of Physical Medicine and Rehabilitation, 63(3), 239.</p><p></p><p>Adnan, R., Rafie, M. H., Ahmad, H., Sulaiman, N., & Ismail, S. I. (2014). Effects of land based and water based walking exe rcise among knee osteoarthritis patients. Journal of advanced medical research, 4(3), 1-12.</p><p></p><p>Adwok, J. (2015). Probability sampling-A guideline for quantitative health care research. Annals of African Surgery, 12(2).</p><p></p><p>Alberton, C. L., Cadore, E. L., Pinto, S. S., Tartaruga, M. P., Da Silva, E. M., & Kruel, L. F. M. (2011). Cardiorespiratory, neuromuscular and kinematic responses to stationary running performed in water and on dry land. European Journal of Applied Physiology, 111(6), 1157-1166.</p><p></p><p>American Academy of Orthopaedic Surgeons [AAOS], (2013). Treatment of Osteoarthritis of the Knee Evidence-Based Guideline, 2nd edition. American Academy of Orthopaedic Surgeons Board of Directors, 1- 973.</p><p></p><p>Anandacoomarasamy, A., Caterson, I., Sambrook, P., Fransen, M., & March, L. (2008). The impact of obesity on the musculoskeletal system. (January 1966), 211222. https://doi.org/10.1038/sj.ijo.0803715</p><p></p><p>Anandacoomarasamy, A., Caterson, I., Sambrook, P., Fransen, M., & March, L. (2008). The impact of obesity on the musculoskeletal system. International journal of obesity, 32(2), 211-222.</p><p></p><p>Anwer, S., Jeelani, S. I., Khan, S. A., Quddus, N., Kalra, S., & Alghadir, A. H. (2021). Effects of TheraBand and Theratube eccentric exercises on quadriceps muscle strength and muscle mass in young adults. BioMed Research International, 2021.</p><p></p><p>Archanah, T., Shashikiran, H. C., Shetty, P., & Chandrakanth, K. K. (2018). Effect of a hydrotherapy based alternate compress on osteoarthritis of the knee joint: a randomized controlled trial. Int J Res Med Sci, 6(4), 1444-1449.</p><p></p><p>Assar, S., Gandomi, F., Mozafari, M., & Sohaili, F. (2020). The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation, 12(1), 1-13.</p><p></p><p>Azizi, S., Dadarkhah, A., Rezasoltani, Z., Raeissadat, S. A., Mofrad, R. K., & Najafi, S. (2020). Randomized controlled trial of AE for treatment of knee osteoarthritis in elderly people. Interventional Medicine and Applied Science, 11(3), 161167. https://doi.org/10.1556/1646.11.2019.19</p><p></p><p>Azlin, O. R. (2011). Effects of Passive Joint Mobilization on Patients with Knee Osteoarthritis. Sains Malaysiana, 40(12), 14611465.</p><p></p><p>MN, N. A., & LYN, K. (2011). Effects of passive joint mobilization on patients with knee osteoarthritis. Sains Malaysiana, 40(12), 1461-1465.</p><p></p><p>Barati, A. H. (2021). Comparison of the effect of aquatic and Thera-band exercise on pain and quality of life in obese people with knee osteoarthritis. Journal of Pain Management, 14(3), 221-229.</p><p></p><p>Bartels, Lund, H., Dagfinrud, & Christensen, D. (2009). AE for the treatment of knee and hip osteoarthritis ( Review ). Cochrane Library, (4).</p><p></p><p>Bartels, E M, Christensen, R., Christensen, P., Henriksen, M., Bennett, A., Gudbergsen, H., Bliddal, H. (2014). Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis : a prospective</p><p>cohort study. Osteoarthritis and Cartilage, 22(11), 18171825. https://doi.org/10.1016/j.joca.2014.07.027</p><p></p><p>Bartels, Else Marie, Juhl, C. B., Christensen, R., Hagen, K. B., Danneskiold-Samse, B., Dagfinrud, H., & Lund, H. (2016). AE for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews, 2016(3). https://doi.org/10.1002/14651858.CD005523.pub3</p><p></p><p>Basmadjian, D., & Quan, F. (1987). Distribution of chemicals in rivers during contamination and recovery. Journal of Environmental Engineering, 113(6), 1185-1201.</p><p></p><p>Batsis, J. A., Zbehlik, A. J., Barre, L. K., Bynum, J. P. W., Pidgeon, D., & Bartels, S. J. (2015). Impact of obesity on disability, function, and physical activity: Data from the Osteoarthritis Initiative. Scandinavian Journal of Rheumatology, 44(6), 495502. https://doi.org/10.3109/03009742.2015.1021376</p><p></p><p>Becker BE, Cole AJ. Comprehensive Aquatic Therapy. 3rd ed. Pullmann, WA: Washington State University Publishing; 2010.</p><p></p><p>Bellamy, N. (1988). Validation study of WOMAC: a health status instrument for measuring clinically important patient-relevant outcomes following total hip or knee arthroplasty in osteoarthritis. J Orthop Rheumatol, 1, 95-108.</p><p></p><p>Bender, T., Karaglle, Z., Blint, G. P., Gutenbrunner, C., Blint, P. V., & Sukenik, S. (2005). Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatology International, 25(3), 220224. https://doi.org/10.1007/s00296-004-0487-4</p><p></p><p>Bennell, K. L., Ahamed, Y., Bryant, C., Jull, G., Hunt, M. A., Kenardy, J., Keefe, F. J. (2012). A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol. BMC Musculoskeletal Disorders, Vol. 13, p. 129. https://doi.org/10.1186/1471-2474-13-129</p><p></p><p>Bennell, K. L., & Hinman, R. S. (2011). A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport / Sports Medicine Australia, 14(1), 49. https://doi.org/10.1016/j.jsams.2010.08.002</p><p></p><p>Bergamin, M., Ermolao, A., Tolomio, S., Berton, L., Sergi, G., & Zaccaria, M. (2013). Water- versus land-based exercise in elderly subjects: Effects on physical performance and body composition. Clinical Interventions in Aging, 8, 1109</p><p>1117. https://doi.org/10.2147/CIA.S44198</p><p></p><p>Bezalel, T., Carmeli, E., & Katz-leurer, M. (2010). The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis : A parallel randomised single-blind clinical trial. Physiotherapy, 96(2), 137143. https://doi.org/10.1016/j.physio.2009.09.009</p><p></p><p>Bliddal, H., Leeds, A. R., & Christensen, R. (2014). Osteoarthritis , obesity and weight loss : evidence , hypotheses and horizons a scoping review. (6). https://doi.org/10.1111/obr.12173</p><p></p><p>Bliddal, H., Leeds, A. R., & Christensen, R. (2014). Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizonsa scoping review. Obesity reviews, 15(7), 578-586.</p><p></p><p>Brosseau, L., Ka, Y., Welch, V., Marchand, S., Judd, M., Ga, W., & Tugwell, P. (2011). Thermotherapy for treatment of osteoarthritis ( Review ). Cochrane Library, (4).</p><p></p><p>Borkhoff, C. M., Wieland, M. L., Myasoedova, E., Ahmad, Z., Welch, V., Hawker, G. A., & Tugwell, P. (2011). Reaching those most in need: a scoping review of interventions to improve health care quality for disadvantaged populations with osteoarthritis. Arthritis care & research, 63(1), 39-52.</p><p></p><p>Bove, A. M., Smith, K. J., Bise, C. G., Fritz, J. M., Childs, J. D., Brennan, G. P., ... & Fitzgerald, G. K. (2018). Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial. Physical therapy, 98(1), 16-27.</p><p></p><p>Candace, W. Y., Kennis, C. K., Evelyn, K. Y., Jeffrey, T. H., Margaret, L. Y., Hwang, S. S., & Shirley, N. P. (2017). Effect of a 4-week Theraband exercise with PNF pattern on improving mobility, balance and fear of fall in community-dwelling elderly. Journal of the Korean Society of Physical Medicine, 12(4), 73-82.</p><p></p><p>Casilda-Lpez, J., Valenza, M. C., Cabrera-Martos, I., Daz-Pelegrina, A., Moreno-Ramrez, M. P., & Valenza-Demet, G. (2017). Effects of a dance-based AE program in obese postmenopausal women with knee osteoarthritis: A randomized controlled trial. Menopause, 24(7), 768773. https://doi.org/10.1097/GME.0000000000000841</p><p></p><p>Cantrell, A. J., Imonugo, O., & Varacallo, M. (2020). Anatomy, Bony Pelvis and Lower Limb, Leg Bones. StatPearls [Internet].</p><p></p><p>Chan, Y. Y., Lim, K. K., Lim, K. H., Teh, C. H., Kee, C. C., Cheong, S. M., ... & Ahmad, N. A. (2017). Physical activity and overweight/obesity among Malaysian adults: findings from the 2015 National Health and morbidity survey (NHMS). BMC Public Health, 17(1), 1-12.</p><p></p><p>Chang, T. F., Liou, T. H., Chen, C. H., Huang, Y. C., & Chang, K. H. (2012). Effects of elastic-band exercise on lower-extremity function among female patients with osteoarthritis of the knee. Disability and Rehabilitation, 34(20), 17271735. https://doi.org/10.3109/09638288.2012.660598</p><p></p><p>Cheung, C., Wyman, J. F., Bronas, U., McCarthy, T., Rudser, K., & Mathiason, M. A. (2017). Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatology International, 37(3), 389398. https://doi.org/10.1007/s00296-016-3620-2</p><p></p><p>Chiquoine, J., Martens, E., McCauley, L., & Van Dyke, J. B. (2018). Aquatic therapy. Canine sports medicine and rehabilitation, 208-226.</p><p></p><p>Cicuttini, A. J. T. yuanyuan W. A. E. W. F. M. (2008). Commentaries Obesity and Knee Osteoarthritis : New Insights Provided by Body Composition Studies. Journal of Obesity, 16(2). https://doi.org/10.1037/oby.2007.30</p><p></p><p>Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates.</p><p></p><p>Collins, N. J., Prinsen, C. A. C., Christensen, R., Bartels, E. M., Terwee, C. B., & Roos, E. M. (2016a). Knee Injury and Osteoarthritis Outcome Score ( KOOS ): systematic review and meta-analysis of measurement properties. Osteoarthritis and Cartilage, 24(8), 13171329. https://doi.org/10.1016/j.joca.2016.03.010</p><p></p><p>Connelly, L. M. (2013). Limitation section. MEDSURG Nursing, 22(5), 2013.</p><p></p><p>Cornelis, E. & Maria, P. (2013). Reducing the impact of geriatric conditions by physical activity. 1-195</p><p></p><p>Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., & Lu, H. (2020). Global, regional revalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine, 29, 100587.</p><p></p><p>da Silva, F. S., de Melo, F. E., do Amaral, M. M., Caldas, V. V., & Pinheiro, . L. D. (2015). Efficacy of simple integrated group rehabilitation program for patients with knee osteoarthritis: Single-blind randomized controlled trial. Journal of rehabilitation research and development, 52(3), 309.</p><p></p><p>de la Cruz, S. P. (2017). Effectiveness of aquatic therapy for the control of pain and increased functionality in people with Parkinson's disease: a randomized clinical trial. European journal of physical and rehabilitation medicine, 53(6), 825-832.</p><p></p><p>Delevatti, R., Marson, E., & Kruel, L. F. (2015). Effect of AE training on lipids profile and glycaemia: A systematic review. Revista Andaluza de Medicina Del Deporte, 8(4), 163170. https://doi.org/10.1016/j.ramd.2014.08.003</p><p></p><p>Dhar, S., & Agarwal, S. (2015a). Effectiveness of an Elastic Band Exercise Protocol in Tri-Compartmental Effectiveness of an Elastic Band Exercise Protocol in Tri-Compartmental Osteoarthritis of the Knee. (September). https://doi.org/10.5958/0973-5674.2015.00076.3</p><p></p><p>Dionne, A., Goulet, S., Leone, M., & Comtois, A. S. (2018). AE training outcomes on functional capacity, quality of life, and lower limb lymphedema: Pilot study. The Journal of alternative and complementary medicine, 24(9-10), 1007-1009.</p><p></p><p>Dong, R., Wu, Y., Xu, S., Zhang, L., Ying, J., Jin, H., Tong, P. (n.d.). Is AE more effective than land-based exercise for knee osteoarthritis?</p><p></p><p>Dong, R., Wu, Y., Xu, S., Zhang, L., Ying, J., Jin, H., ... & Tong, P. (2018). Is AE more effective than land-based exercise for knee osteoarthritis?. Medicine, 97(52).</p><p></p><p>Dulcy, F. H. (1983). Aquatic programs for disabled children: an overview and an analysis of the problems. Physical & Occupational Therapy in Pediatrics, 3(1), 1-20.</p><p></p><p>Dundar, U., Solak, O., Toktas, H., Demirdal, U. S., Subasi, V., Kavuncu, V. U. R. A. L., & Evcik, D. (2014). Effect of AE on ankylosing spondylitis: a randomized controlled trial. Rheumatology international, 34(11), 1505-1511.</p><p></p><p>Dunlop, D. D., Song, J., Semanik, P. a, Sharma, L., & Chang, R. W. (2011). Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis and Rheumatism, 63(1), 127136. https://doi.org/10.1002/art.27760</p><p></p><p>Edwards, a. M., Maguire, G. P., Graham, D., Boland, V., & Richardson, G. (2012). Four weeks of inspiratory muscle training improves self-paced walking performance in overweight and obese adults: A randomised controlled trial. Journal of Obesity, 2012. https://doi.org/10.1155/2012/918202</p><p></p><p>Esser, S., & Bailey, A. (2011). Effects of Exercise and Physical Activity on Knee Osteoarthritis. Current Pain and Headache Reports, Vol. 15, pp. 423430.</p><p>https://doi.org/10.1007/s11916-011-0225-z</p><p></p><p>Egerton, T., Danoudis, M., Huxham, F., & Iansek, R. (2011). Central gait control mechanisms and the stride lengthcadence relationship. Gait & posture, 34(2), 178-182.</p><p></p><p>Exercises, C., & Science, S. (2020). 1 , 2* , 3 1. 7(3), 2635.</p><p></p><p>Farr II, J., Miller, L. E., & Block, J. E. (2013). Quality of Life in Patients with Knee Osteoarthritis: A Commentary on Nonsurgical and Surgical Treatments. The Open Orthopaedics Journal, 7(1), 619623. https://doi.org/10.2174/1874325001307010619</p><p></p><p>Farrokhi, S., Connell, M. O., Gil, D. P. T. A. B., Sparto, P. J., & Fitzgerald, G. K. (2015). Altered Gait Characteristics in Individuals With Knee Osteoarthritis and Self-Reported Knee Instability. 45(5), 351359. https://doi.org/10.2519/jospt.2015.5540</p><p></p><p>Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods, 41(4), 1149-1160.</p><p></p><p>Feeney, J. A. (1995). Adult attachment and emotional control. Personal relationships, 2(2), 143-159.</p><p></p><p>Felson, D. T. & McAlindon. (2000). NIH Conference Osteoarthritis : New Insights. Annals of Internal Medicine, 133 (8), 637639.</p><p></p><p>Fernandes, L., Hagen, K. B., Bijlsma, J. W., Andreassen, O., Christensen, P., Conaghan, P. G., ... & Vlieland, T. P. V. (2013). EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Annals of the rheumatic diseases, 72(7), 1125-1135.</p><p></p><p>Fisken, A. L., Waters, D. L., Hing, W. A., Steele, M., & Keogh, J. W. (2015). Comparative effects of 2 aqua exercise programs on physical function, balance, and perceived quality of life in older adults with osteoarthritis. Journal of Geriatric Physical Therapy, 38(1), 1727. https://doi.org/10.1519/JPT.0000000000000019</p><p></p><p>Flandry, F., & Hommel, G. (2011). Normal anatomy and biomechanics of the knee. Sports medicine and arthroscopy review, 19(2), 82-92.</p><p></p><p>Fjeldstad, C., Fjeldstad, A. S., Acree, L. S., Nickel, K. J., & Gardner, A. W. (2008).</p><p>The influence of obesity on falls and quality of life. Dynamic Medicine, 7(1), 1-6.</p><p></p><p>Foley, A., Halbert, J., Hewitt, T., & Crotty, M. (2003). Does hydrotherapy improve strength and physical function in patients with osteoarthritis - A randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Annals of the Rheumatic Diseases, 62(12), 11621167. https://doi.org/10.1136/ard.2002.005272</p><p></p><p>Foo, C. N., Manohar, A., Rampal, L., Lye, M. S., Mohd-Sidik, S., & Osman, Z. J. (2017). Knee pain and functional disability of knee osteoarthritis patients seen at Malaysian government hospitals. Malaysian Journal of Medicine and Health Sciences, 13(2), 715.</p><p></p><p>Fransen, M., McConnell, S., & Bell, M. M. (2001). Exercise for osteoarthritis of the hip or knee. Cochrane Database of Systematic Reviews, (2).</p><p></p><p>Fransen, M, Mcconnell, S., Ar, H., M, V. D. E., Simic, M., & Kl, B. (2015). Exercise for osteoarthritis of the knee ( Review ). https://doi.org/10.1002/14651858.CD004376.pub3.www.cochranelibrary.com</p><p></p><p>Fransen, Marlene, Bridgett, L., March, L., Hoy, D., Penserga, E., & Brooks, P. (2011). The epidemiology of osteoarthritis in Asia. International Journal of Rheumatic Diseases, 113121.</p><p></p><p>Fukumoto, Y., Tateuchi, H., Ikezoe, T., Tsukagoshi, R., Akiyama, H., So, K., ... & Ichihashi, N. (2014). Effects of high-velocity resistance training on muscle function, muscle properties, and physical performance in individuals with hip osteoarthritis: a randomized controlled trial. Clinical rehabilitation, 28(1), 48-58.</p><p></p><p>Garvey, J. E., Dugger, B. D., Whiles, M. R., Adams, S. R., Flinn, M. B., Burr, B. M., & Sheehan, R. J. (2003). Responses of fishes, waterbirds, invertebrates, vegetation, and water quality to environmental pool management: Mississippi River Pool 25.</p><p></p><p>Gay, C., Eschalier, B., Levyckyj, C., Chabaud, A., & Coudeyre, E. (2015). Facilitators and Barriers in physical activity engagement for knee osteoarthritis patients. Annals of Physical and Rehabilitation Medicine, 58, e94.</p><p></p><p>Gelber, A. C., Hochberg, M. C., Mead, L. A., Wang, N. Y., Wigley, F. M., & Klag, M. J. (1999). Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. The American journal of medicine, 107(6), 542-548.</p><p></p><p>Gremeaux, V., Troisgros, O., Benam, S., Hannequin, A., Laurent, Y., Casillas, J. M.</p><p>& Benam, C. (2011). Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Archives of Physical Medicine and Rehabilitation, 92 (4), 611619.</p><p></p><p>Greene, M. a., & Loeser, R. F. (2015). Aging-related inflammation in osteoarthritis. Osteoarthritis and Cartilage, 23, 19661971. https://doi.org/10.1016/j.joca.2015.01.008</p><p></p><p>Govoni, J. J., & Forward, R. B. (2020). Buoyancy. In Fish larval physiology (pp. 495-521). CRC Press.</p><p></p><p>Gu, Y. Y., Chen, J., Meng, Z. L., Ge, W. Y., Bian, Y. Y., Cheng, S. W., Peng, L. (2017). Research progress on osteoarthritis treatment mechanisms. Biomedicine and Pharmacotherapy, 93, 12461252. https://doi.org/10.1016/j.biopha.2017.07.034</p><p></p><p>Ha, G. C., Yoon, J. R., Yoo, C. G., Kang, S. J., & Ko, K. J. (2018). Effects of 12-week AE on cardiorespiratory fitness, knee isokinetic function, and Western Ontario and McMaster University osteoarthritis index in patients with knee osteoarthritis women. Journal of exercise rehabilitation, 14(5), 870</p><p></p><p>Hacken, B., Edwards, C., Rogers, A., Vm, C., Mosher, T., Lynch, S., Black, K. (2014). The Effects of Bariatric Surgery Weight Loss on Knee Pain in Patients with Knee Osteoarthritis : 2 Year Follow-up. 3(3), 26. https://doi.org/10.4172/2167-7921.1000132</p><p></p><p>Hall, M., Dobson, F., Plinsinga, M., Mailloux, C., Starkey, S., Smits, E., ... & Masse-Alarie, H. (2020). Effect of exercise on pain processing and motor output in people with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis and Cartilage, 28(12), 1501-1513.</p><p></p><p>Hale, L. A., Waters, D., & Herbison, P. (2012). A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Archives of physical medicine and rehabilitation, 93(1), 27-34.</p><p></p><p>Haralson, K. M. (1985). Therapeutic pool programs. Clinical Management, 5(2), 10-13.</p><p></p><p>Harding, G. T., Hubley-Kozey, C. L., Dunbar, M. J., Stanish, W. D., & Astephen Wilson, J. L. (2012). Body mass index affects knee joint mechanics during gait differently with and without moderate knee osteoarthritis. Osteoarthritis and</p><p>Cartilage, 20(11), 12341242. https://doi.org/10.1016/j.joca.2012.08.004</p><p></p><p>Hart, J. M., Pietrosimone, B., Hertel, J. & Ingersoll, C. D. (2010). Quadriceps Activation Following Knee Injuries. Journal of Athletic Training, 45 (1), 8797.</p><p></p><p>Haupenthal, A., de Brito Fontana, H., Ruschel, C., dos Santos, D. P., & Roesler, H. (2013). Ground reaction forces in shallow water running are affected by immersion level, running speed and gender. Journal of Science and Medicine in Sport, 16(4), 348-352.</p><p></p><p>Hawker, G. a, Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF. Arthritis Care & Research, 63 Suppl 1(November), S240-52. https://doi.org/10.1002/acr.20543</p><p></p><p>Heidari, B. (2011). Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian journal of internal medicine, 2(2), 205.</p><p></p><p>Helminen, E.-E., Sinikallio, S. H., Valjakka, A. L., Visnen-Rouvali, R. H., & Arokoski, J. P. (2013). Effectiveness of a cognitive-behavioral group intervention for knee osteoarthritis pain: protocol of a randomized controlled trial. BMC Musculoskeletal Disorders, 14, 46. https://doi.org/10.1186/1471-2474-14-46</p><p></p><p>Henriksen, M., Christensen, R., Danneskiold-Samse, B., & Bliddal, H. (2012). Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: a prospective cohort study. Arthritis and Rheumatism, 64(2), 438442. https://doi.org/10.1002/art.33394</p><p></p><p>Heywood, S. (2019). Specificity of functional exercise in water compared to on land: Understanding biomechanics to improve the clinical effectiveness of aquatic rehabilitation (Doctoral dissertation, University of the Sunshine Coast).</p><p></p><p>Hinman, R. S., Heywood, S. E., & Day, A. R. (2007). Aquatic physical therapy for hip and knee osteoarthritis: Results of a single-blind randomized controlled trial. Physical Therapy, 87(1), 3243. https://doi.org/10.2522/ptj.20060006</p><p></p><p>Honorato, V. C., Rossato, S. L., Fuchs, F. D., Harzheim, E. & Fuchs, S. C. (2013). Assessment of primary health care received by the elderly and health related quality of life : A cross-sectional study. BMC Public Health, 13, 605-614.</p><p></p><p>Impivaara, O., Arokoski, J. P. A., Toivanen, A. T., Helio, M., Knekt, P., Lauren, H., & Kro, H. (2010). Original article Obesity , physically demanding work and traumatic knee injury are major risk factors for knee osteoarthritis a population-based study with a follow-up of 22 years. Journal of Rheumatology, 49(November 2009), 308314. https://doi.org/10.1093/rheumatology/kep388</p><p></p><p>Institute of Public health. (2011). National Health And Morbidity Survey 2011 NHMS 2011 Background NHMS 2011 Highlights NHMS 2011 Objectives NHMS 2011 Methodology National Health And Morbidity Survey 2011.</p><p></p><p>Institute of Public health. (2015). National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems. In Ministry of health. https://doi.org/10.1017/CBO9781107415324.004</p><p></p><p>Jansen, M. J., Viechtbauer, W., Lenssen, A. F., Hendriks, E. J. M. & De Bie, R. A. (2011). Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: A systematic review. Journal of Physiotherapy, 57 (1), 1120.</p><p></p><p>Jette, A. M., Lachman, M., Giorgetti, M. M., Assmann, S. F., Harris, B. A., Levenson, C., ... & Krebs, D. (1999). Exercise--it's never too late: the strong-for-life program. American journal of public health, 89(1), 66-72.</p><p></p><p>Kadir, A. (2018). Traditional and Complementary Medicine Use in Knee Osteoarthritis and its Associated Factors Among Patients in Northeast Peninsular Malaysia. 33(2), 148153. https://doi.org/10.5001/omj.2018.27</p><p></p><p>Khruakhorn, S., & Chiwarakranon, S. (2021). Effects of hydrotherapy and land-based exercise on mobility and quality of life in patients with knee osteoarthritis: a randomized control trial. Journal of Physical Therapy Science, 33(4), 375-383.</p><p></p><p>Kamsan, S. S., Singh, D. K. A., Tan, M. P., & Kumar, S. (2021). Healthcare Utilization and Knee Osteoarthritis Symptoms among Urban Older Malaysian. International journal of environmental research and public health, 18(7), 3777.</p><p></p><p>Kamyabnia, M., Jourkesh, M. & Keikha, B. M. (2011). Comparison of Physical Fitness level among normal weight and Obese Female University students. Annals of Biological Research, 2 (3), 126133.</p><p></p><p>Kargarfard, M., Etemadifar, M., Baker, P., Mehrabi, M., & Hayatbakhsh, R. (2012). Effect of AE training on fatigue and health-related quality of life in patients with</p><p>multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 93(10), 17011708. https://doi.org/10.1016/j.apmr.2012.05.006</p><p></p><p>Kars Fertelli, T., Mollaoglu, M., & Sahin, O. (2019). AE Program for Individuals with Osteoarthritis: Pain, Stiffness, Physical Function, Self-Efficacy. Rehabilitation Nursing, 44(5), 290299. https://doi.org/10.1097/rnj.0000000000000142</p><p></p><p>Kashiani, A. B., Soh, K. G., Yusof, A., & Soh, K. L. (2019). Effects of 12 weeks combined weight and chain versus combined weight and elastic band variable resistance training on upper and lower body muscular strength and endurance among recreational weight-lifter males in Iran. International Journal of Pharmaceutical Research, 11(1), 779790. https://doi.org/10.15282/mohe.v9i1.338</p><p></p><p>Kellgren, J. H. & Lawrence, J. S. (1957). Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 16(4):494-502</p><p></p><p>Khan, M., Soomro, R. R., & Ali, S. S. (2014). The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specific neck pain. 27(5), 17191722.</p><p></p><p>Khoja, S. S., Susko, A. M., Josbeno, D. A., Piva, S. R., & Fitzgerald, G. K. (2014). Comparing physical activity programs for managing osteoarthritis in overweight or obese patients. Journal of Comparative Effectiveness Research, 3(3), 283-299.</p><p></p><p>Khruakhorn, S., & Chiwarakranon, S. (2021). Effects of hydrotherapy and land-based exercise on mobility and quality of life in patients with knee osteoarthritis: a randomized control trial. Journal of Physical Therapy Science, 33(4), 375-383.</p><p></p><p>Kim, I. S., Chung, S. H., Park, Y. J., & Kang, H. Y. (2012). The effectiveness of an aquarobic exercise program for patients with osteoarthritis. Applied Nursing Research, 25(3), 181-189.</p><p></p><p>Kloek, C. J., Van Dongen, J. M., De Bakker, D. H., Bossen, D., Dekker, J., & Veenhof, C. (2018). Cost-effectiveness of a blended physiotherapy intervention compared to usual physiotherapy in patients with hip and/or knee osteoarthritis: a cluster randomized controlled trial. BMC Public Health, 18(1), 1-12.</p><p></p><p>Kloppenburg, M., & Berenbaum, F. (2020). Osteoarthritis year in review 2019: epidemiology and therapy. Osteoarthritis and Cartilage, 28(3), 242248. https://doi.org/10.1016/j.joca.2020.01.002</p><p></p><p>Knoop, J., Steultjens, M. P. M., Van der Leeden, M., Van der Esch, M., Thorstensson,</p><p>C. A., Roorda, L. D., ... & Dekker, J. (2011). Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis and Cartilage, 19(4), 381-388.</p><p></p><p>Kroon, V. D. B., Buchbinder, R., Rh, O., Rv, J., & Pitt, V. (2014). Self-management education programmes for osteoarthritis ( Review ). Cochrane Library, (1).</p><p></p><p>Kulkarni, K., Karssiens, T., Kumar, V., & Pandit, H. (2016). Obesity and osteoarthritis. Maturitas, 89, 22-28.</p><p></p><p>Kumar, S., Faruq, N. M., Khan, A. A., Kumar, K., & Jaffer, M. (2012). Is Over-Weight and Obesity associated with High Frequency of Co-Morbid Conditions ? Pakistan Journal of Rehabilitation, 1(2), 6873.</p><p></p><p>Kuptniratsaikul, V., Kittichaikarn, C., Suntornpiyapan, P., Kovintaset, K., & Inthibal, S. (2019). Is four-week underwater treadmill exercise regimen compared to home exercise efficacious for pain relief and functional improvement in obese patients with knee osteoarthritis? A randomized controlled trial. Clinical Rehabilitation, 33(1), 85-93. https://doi.org/10.1177/0269215518792041</p><p></p><p>Kushner, R. F., & Foster, G. D. (2000). Obesity and quality of life. Nutrition, 16(10), 947-952.</p><p></p><p>Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in psychology, 4, 863.</p><p></p><p>Leary, V. B. O., Marchetti, C. M., Krishnan, R. K., & Stetzer, B. P. (2005). Exercise-induced reversal of Insulin Resistance in Obese Elderly is associated with reduced Visceral Fat. Journal of Applied PhysiologyPhysiology, 8(2), 127. https://doi.org/10.1152/japplphysiol.01336.2005</p><p></p><p>Lee, D. W., Kim, S., & Cho, D. Y. (2012). Obesity-Related Quality of Life and Distorted Self-Body Image in Adults. Applied Research in Quality of Life, 8(1), 87100. https://doi.org/10.1007/s11482-012-9174-x</p><p></p><p>Lee, S. W., Patel, J., Napatkamon, A., Aguilla, E., Hill, J., & Bartels, M. N. (2020). Effect of Comorbid Chronic Low Back Pain on Patient-Reported Outcome and Gait Parameters in Patients With Symptomatic Knee Osteoarthritis. American Journal of Physical Medicine & Rehabilitation, 99(12), 1184-1188.</p><p></p><p>Lee, C. H., & Kim, I. H. (2021). AE and land exercise treatments after total knee replacement arthroplasty in elderly women: a comparative study. Medicina, 57(6), 589.</p><p>Len-Ballesteros, S., Espinosa-Morales, R., Clark-Peralta, P., Gmez-Pineda, A. G., & Guadarrama-Becerril, J. H. (2020). Kinesiotape and quadriceps strengthening with elastic band in women with knee osteoarthritis and overweight or obesity. A randomized clinical trial. Reumatologa Clnica (English Edition), 16(1), 11-16.</p><p></p><p>Lepore, M., Gayle, G. W., & Stevens, S. F. (1998). Adapted aquatics programming: A professional guide. Human Kinetics, PO Box 5076, Champaign, IL 61825-5076.</p><p></p><p>Li, J. S., Hosseini, A., Gadikota, H. R., & Li, G. (2018). Kinesiology of the knee joint. Orthopaedic Basic Science: Foundations of Clinical Practice, Fourth Edition, 261278. https://doi.org/10.1016/b978-0-12-812162-7.00022-9</p><p></p><p>Liao, C.-D., Chiu, Y.-S., Ku, J.-W., Huang, S.-W., & Liou, T.-H. (2020). Effects of Elastic Resistance Exercise on Postoperative Outcomes Linked to the ICF Core Sets for Osteoarthritis after Total Knee Replacement in Overweight and Obese Older Women with Sarcopenia Risk: A Randomized Controlled Trial. Journal of Clinical Medicine, 9(7), 2194. https://doi.org/10.3390/jcm9072194</p><p></p><p>Liao, C., Tsauo, J., Huang, S., Ku, J., & Hsiao, D. (2018). Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity : A randomized controlled trial. Scientific Reports, (January), 113. https://doi.org/10.1038/s41598-018-20677-7</p><p></p><p>Lim, J. Y., Tchai, E., & Jang, S. N. (2010). Effectiveness of AE for obese patients with knee osteoarthritis: a randomized controlled trial. Pm&r, 2(8), 723-731.</p><p></p><p>Lu, M., Su, Y., Zhang, Y., Zhang, Z., Wang, W., He, Z., Zheng, N. (2015). Effectiveness of AE for treatment of knee osteoarthritis. 543552. https://doi.org/10.1007/s00393-014-1559-9</p><p></p><p>Lund, H., Weile, U., Christensen, R., Rostock, B., Downey, A., Bartels, E. M., Bliddal, H. (2008a). A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. Journal of Rehabilitation Medicine, 40(2), 137144. https://doi.org/10.2340/16501977-0134</p><p></p><p>Malanga, G., Niazi, F., Kidd, V. D., Lau, E., Kurtz, S. M., Ong, K. L., & Concoff, A. L. (2020). Knee osteoarthritis treatment costs in the medicare patient population. American health & drug benefits, 13(4), 144.</p><p></p><p>Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiotherapy theory and practice, 32(5), 332-355.</p><p></p><p>Lopera, C. A., da Silva, D. F., Bianchini, J. A. A., Locateli, J. C., Moreira, A. C. T., Dada, R. P., ... & Junior, N. N. (2016). Effect of water-versus land-based exercise training as a component of a multidisciplinary intervention program for overweight and obese adolescents. Physiology & behavior, 165, 365-373.</p><p></p><p>Macko, S. D., Manley, M. L., Maul, C. A., Roth, B. E., & Sakalas, M. A. (1999). Effectiveness of Thera-Band. on strengthening the shoulder external rotators. Physical Therapy, 79(5), S82.</p><p></p><p>Malfait, A. M. (2016). Osteoarthritis year in review 2015: biology. Osteoarthritis and Cartilage, 24(1), 21-26.</p><p></p><p>Marconcin, P., Espanha, M., Teles, J., Bento, P., Campos, P., Andr, R., & Yzigi, F. (2018). A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program. Clinical Rehabilitation, 32(2), 223232. https://doi.org/10.1177/0269215517718892</p><p></p><p>Marcos, J., Cisneros, L., Dias, R., Fritsch, C., Gomes, W., Pereira, L., Henrique, P. (2017). Brazilian Journal of Hydrotherapy improves pain and function in older women with knee osteoarthritis : a randomized controlled trial. Brazilian Journal of Physical Therapy, 613. https://doi.org/10.1016/j.bjpt.2017.06.012</p><p></p><p>Masiero, S., Vittadini, F., Ferroni, C., Bosco, A., Serra, R., Frigo, A. C., & Frizziero, A. (2018b). The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. International Journal of Biometeorology, 62(2), 243252. https://doi.org/10.1007/s00484-017-1445-7</p><p></p><p>Mat, S., Jaafar, M. H., Ng, C. T., Sockalingam, S., Raja, J., Kamaruzzaman, S. B., ... & Tan, M. P. (2019). Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians. Plos one, 14(11), e0225075.</p><p></p><p>McAlindon, T. E., Bannuru, R. R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M. & Underwood, M. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22 (3), 363388.</p><p></p><p>McDougall, J. J. (2006). Arthritis and pain. Neurogenic origin of joint pain. Arthritis Research and Therapy, 8, 110. https://doi.org/10.1186/ar2069</p><p></p><p>McWilliams, D. F., Leeb, B. F., Muthuri, S. G., Doherty, M., & Zhang, W. (2011). Occupational risk factors for osteoarthritis of the knee: a meta-analysis.</p><p>Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society, 19(7), 829839. https://doi.org/10.1016/j.joca.2011.02.016</p><p></p><p>Meili, L., Youxin, S., Yingjie, Z., Ziyi, Z., Wenting, W., Zhen, H., ... & Naixi, Z. (2015). Effectiveness of AE for treatment of knee osteoarthritis. Zeitschrift fr Rheumatologie, 74(6), 543-552.</p><p></p><p>Melzack, R., Wall, P. D., Steptoe, A., & Wardle, J. (1994). Pain mechanisms: A new theory. Psychosocial processes and health: A reader, 112-131</p><p></p><p>Meryem, B., & Fatma, A. (2014). Quality of life and self-reported disability in patients with knee osteoarthritis. 7595(1), 166171. https://doi.org/10.3109/14397595.2013.854046</p><p></p><p>Mikesky, A. E., Mazzuca, S. A., Brandt, K. D., Perkins, S. M., Damush, T., & Lane, K. A. (2006). Effects of Strength Training on the Incidence and Progression of Knee Osteoarthritis. 55(5), 690699. https://doi.org/10.1002/art.22245</p><p></p><p>Miller, C. T., Fraser, S. F., Levinger, I., Straznicky, N. E., Dixon, J. B., Reynolds, J., & Selig, S. E. (2013). The effects of exercise training in addition to energy restriction on functional capacities and body composition in obese adults during weight loss: A systematic review. PLoS ONE, 8(11). https://doi.org/10.1371/journal.pone.0081692</p><p></p><p>Miller, C. T., Fraser, S. F., Selig, S. E., Rice, T., Grima, M., Straznicky, N. E., Dixon, J. B. (2016). The functional and clinical outcomes of exercise training following a very low energy diet for severely obese women: study protocol for a randomised controlled trial. Trials, 17, 125. https://doi.org/10.1186/s13063-016-1232-5</p><p></p><p>Ministry of Health Malaysia. (2018). Pain as The 5 th Vital Sign Guideline : 3 rd Edition.</p><p></p><p>Mora, J. C., Przkora, R., & Cruz-Almeida, Y. (2018). Knee osteoarthritis: Pathophysiology and current treatment modalities. Journal of Pain Research, 11, 21892196. https://doi.org/10.2147/JPR.S154002</p><p></p><p>MPA Tech. committee. (2003). Physiotherapy Care Protocol- Knee Algofunction.</p><p></p><p>Munukka, M., Waller, B., Rantalainen, T., Hkkinen, A., Nieminen, M. T., Lammentausta, E., Heinonen, A. (2016). Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis and</p><p>Cartilage, 24(10), 17081717. https://doi.org/10.1016/j.joca.2016.05.007</p><p></p><p>Musumeci, G. (2016). The effect of mechanical loading on articular cartilage.</p><p></p><p>Musumeci, G. (2017). Functional anatomy in knee osteoarthritis: patellofemoral joint vs. tibiofemoral joint. Journal of Functional Morphology and Kinesiology, 2(1), 8.</p><p></p><p>Mooventhan, A., & Nivethitha, L. (2014). Scientific evidence-based effects of hydrotherapy on various systems of the body. North American journal of medical sciences, 6(5), 199.</p><p></p><p>National Clinical Guideline Centre, U. (2014). Osteoarthritis: care and management in adults. Retrieved June 22, 2016, from https://www.nice.org.uk/guidance/cg177/evidence/full-guideline- 191761309</p><p></p><p>National Institute for Care and Health Excellence. (2021). Osteoarthritis : care and management. NICE Guidelines, (December 2020).</p><p></p><p>Naugle, K. M., Higgins, T. J., & Manini, T. M. (2012). Obesity and use of compensatory strategies to perform common daily activities in pre-clinically disabled older adults. Archives of Gerontology and Geriatrics, 54(2), e134e138. https://doi.org/10.1016/j.archger.2011.10.017</p><p></p><p>Nazaimoon, W., Mohamud, W., Musa, K. I., Sharifuddin, A., Frcp, K., Ismail, A., Mrcp, I. (2011). Short Communication Prevalence of overweight and obesity among adult Malaysians : an update. Asia Pacific Journal Clinical Nutrition, 20(May 2010), 3541.</p><p></p><p>NICE. (2014). Managing overweight and obesity in adults lifestyle weight management services (p.57). Retrieved from World Wide web :https://www.nhlbi.nih.gov/health.</p><p></p><p>Nik Mohd Hatta, N. N. K., & Che Hasan, M. K. (2019). A Review on Osteoarthritis and Osteoporosis: Ongoing Challenges for Musculoskeletal Care. International Journal of Care Scholars, 2(2), 1420. Retrieved from https://journals.iium.edu.my/ijcs/index.php/ijcs/article/view/127</p><p></p><p>Noordin, M. H. M., Ahmad, H., & Baharin, S. (2015). Hydrotherapy : An Innovative Treatment for Obese Malaysians. 020003. https://doi.org/10.1063/1.4937018</p><p></p><p>Pan, J., Wang, B., Li, W., Zhou, X., Scherr, T., Yang, Y., Wang, L. (2012). Elevated cross-talk between subchondral bone and cartilage in osteoarthritic</p><p>joints. Bone, 51(2), 212217. https://doi.org/10.1016/j.bone.2011.11.030</p><p></p><p>Patel, S., Hossain, F. S., Paton, B., & Haddad, F. S. (2010). The effects of a non-operative multimodal programme on osteoarthritis of the knee. Orthopaedic Surgery, 92, 467471. https://doi.org/10.1308/003588410X12664192076052</p><p></p><p>Patil, S. J., Nirmale, D. M., & Kore, P. S. (2020). Rehabilitation Of A Mentally Disabled Patient.</p><p>Prez-de la Cruz, S. (2021). Comparison between three therapeutic options for the treatment of balance and gait in stroke: A randomized controlled trial. International journal of environmental research and public health, 18(2), 426.</p><p></p><p>Pinto, D., Robertson, M. C., Hansen, P., & Abbott, J. H. (2012). Cost-effectiveness of nonpharmacologic, nonsurgical interventions for hip and/or knee osteoarthritis: systematic review. Value in Health : The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 15(1), 112. https://doi.org/10.1016/j.jval.2011.09.003</p><p></p><p>Pisters, M. F., Veenhof, C., Schellevis, F. G., De Bakker, D. H., & Dekker, J. (2010). Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society, 18(8), 10191026. https://doi.org/10.1016/j.joca.2010.05.008</p><p></p><p>Portney, L. G., & Watkins, M. P. (2000). Foundations of Clinical Research : Applications to Practise.</p><p></p><p>Rafael Samper-Ternent, MD, P. C. and S. A. S. (2013). Obesity in Older Adults: Epidemiology and Implications for Disability and Disease. Review Clinical Gerontology, 22(1), 1034.</p><p></p><p>Ramirez, G., Shaw, S. T., & Maloney, E. A. (2018). Math anxiety: Past research, promising interventions, and a new interpretation framework. Educational Psychologist, 53(3), 145-164.</p><p></p><p>Rejeski, W. J., Focht, B. C., Messier, S. P., Morgan, T., Pahor, M., & Penninx, B. (2002). Obese, older adults with knee osteoarthritis: Weight loss, exercise, and quality of life. Health Psychology, 21(5), 419426. https://doi.org/10.1037/0278-6133.21.5.419</p><p></p><p>Rewald, S., Lenssen, A. F. T., Emans, P. J., de Bie, R. A., van Breukelen, G., & Mesters, I. (2020). Aquatic Cycling Improves Knee Pain and Physical</p><p>Functioning in Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 101(8), 12881295. https://doi.org/10.1016/j.apmr.2019.12.023</p><p></p><p>Rewald, S., Mesters, I., Lenssen, A. F., Emans, P. J., Wijnen, W., & De Bie, R. A. (2016). Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: Study protocol of a randomised controlled trial Rehabilitation, physical therapy and occupational health. BMC Musculoskeletal Disorders, 17(1), 114. https://doi.org/10.1186/s12891-016-0939-5</p><p></p><p>Rezasoltani, Z., Sanati, E., Kazempour Mofrad, R., Azizi, S., Dadarkhah, A., & Najafi, S. (2020). Randomized Controlled Trial of Aquatic Cycling for Treatment of Knee Osteoarthritis in Elderly People. Topics in Geriatric Rehabilitation, 36(2), 103109. https://doi.org/10.1097/TGR.0000000000000264</p><p></p><p>Rhon, D., Deyle, G., Gill, N., & Rendeiro, D. (2013). Manual physical therapy and perturbation exercises in knee osteoarthritis. The Journal of Manual & Manipulative Therapy, 21, 220228.</p><p></p><p>Richette, P., Poitou, C., Garnero, P., Vicaut, E., Bouillot, J.-L., Lacorte, J.-M., Chevalier, X. (2011). Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Annals of the Rheumatic Diseases, 70(1), 139144. https://doi.org/10.1136/ard.2010.134015</p><p></p><p>Rogers, M. W., & Wilder, F. V. (2008). The association of BMI and knee pain among persons with radiographic knee osteoarthritis: a cross-sectional study. BMC musculoskeletal disorders, 9(1), 1-6.</p><p></p><p>Roos, E. M., & Arden, N. K. (2015). osteoarthritis. Nature Publishing Group, 110. https://doi.org/10.1038/nrrheum.2015.135</p><p></p><p>Roos, E. M., & Arden, N. K. (2016). Strategies for the prevention of knee osteoarthritis. Nature Reviews Rheumatology, 12(2), 92101. https://doi.org/10.1038/nrrheum.2015.135</p><p></p><p>Roos, E. M., Herzog, W., Block, J. a, & Bennell, K. L. (2011). Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nature Reviews. Rheumatology, 7(1), 5763. https://doi.org/10.1038/nrrheum.2010.195</p><p></p><p>Roos, E. M., & Lohmander, L. S. (2003a). The Knee injury and Osteoarthritis Outcome Score ( KOOS ): from joint injury to osteoarthritis Pilot study. 8, 18.</p><p></p><p>Roos, E. M., & Lohmander, L. S. (2003b). The Knee injury and Osteoarthritis Outcome Score (KOOS): From joint injury to osteoarthritis. Health and Quality of Life Outcomes, 1, 18. https://doi.org/10.1186/1477-7525-1-64</p><p></p><p>Roesler, H., Haupenthal, A., Schtz, G. R., & de Souza, P. V. (2006). Dynamometric analysis of the maximum force applied in aquatic human gait at 1.3 m of immersion. Gait & posture, 24(4), 412-417.</p><p></p><p>Rosen, A. B., Wellsandt, E., Nicola, M., & Tao, M. A. (2021). Current Clinical Concepts: Clinical Management of Patellar Tendinopathy. Journal of Athletic Training.</p><p></p><p>Rosman Azmillah;, Asmahan, M. I., Abdullah, A. W., Gupta, E. Das, Suk Chyn, G., Habibah, M. Y., Hussein, H. (2013). Management of Osteoarthriris 2nd Edition (Malaysia). Malaysia Health Technology Assessment Section (MaHTAS), (December), 152.</p><p></p><p>Salkind, N. J. (2010). Exploring Research. Kansas: Pearson, Prentice Hall.</p><p></p><p>Saragiotto, B. T., Fioratti, I., Deveza, L., Yamato, T. P., Richards, B. L., Maher, C. G., ... & Costa, L. O. P. (2020). Telerehabilitation for hip or knee osteoarthritis (Protocol).</p><p></p><p>Sasek, C. (2015). knee osteoarthritis. Journal of the American Academy of Physician Assistants, 3743. https://doi.org/10.1097/01.JAA.0000458853.38655.02</p><p></p><p>Segal, N. A., Glass, N. A., Torner, J., Yang, M., Felson, D. T., Sharma, L., Lewis, C. E. (2010). Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis and Cartilage, 18(6), 769775. https://doi.org/10.1016/j.joca.2010.02.002</p><p></p><p>Sekome, K., & Maddocks, S. (2019). The short-term effects of hydrotherapy on pain and self-perceived functional status in individuals living with osteoarthritis of the knee joint. South African Journal of Physiotherapy, 75(1), 16. https://doi.org/10.4102/sajp.v75i1.476</p><p></p><p>Shahabi, S., Rezapour, A., & Arabloo, J. (2021). Economic evaluations of physical rehabilitation interventions in older adults with hip and/or knee osteoarthritis: a systematic review. European Journal of Physiotherapy, 23(3), 185-195.</p><p></p><p>Shamliyan T. A., Shi-Yi, W., Olson-Kellogg, B. & Kane, R. L. (2012). Interventions for Knee Pain Secondary to Osteoarthritis. Effective Health Care Program, 77, 1-337.</p><p></p><p>Shi, Z., Zhou, H., Lu, L., Pan, B., Wei, Z., Yao, X., Feng, S. (2018). AEs in the Treatment of Low Back Pain: A Systematic Review of the Literature and Meta-Analysis of Eight Studies. American Journal of Physical Medicine and Rehabilitation, 97(2), 116122. https://doi.org/10.1097/PHM.0000000000000801</p><p></p><p>Shoepe, T. C., Ramirez, D. A., & Almstedt, H. C. (2010). Elastic band prediction equations for combined free-weight and elastic band bench presses and squats. The Journal of Strength & Conditioning Research, 24(1), 195-200.</p><p></p><p>Sibella, F., Galli, M., Romei, M., Montesano, A., & Crivellini, M. (2003). Biomechanical analysis of sit-to-stand movement in normal and obese subjects. Clinical Biomechanics, 18(8), 745750. https://doi.org/10.1016/S0268-0033(03)00144-X</p><p></p><p>Silva, L. E., Valim, V., Pessanha, A. P. C., Oliveira, L. M., Myamoto, S., Jones, A., & Natour, J. (2008). Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Physical therapy, 88(1), 12-21.</p><p></p><p>Sim, J. O. (2016). Effects of resistance exercise using elastic band on range of motion, function and shoulder pain among patients with rotator cuff repair. Korean Journal of Adult Nursing, 28(5), 491500. https://doi.org/10.7475/kjan.2016.28.5.491</p><p></p><p>Slemenda, C., Heilman, D. K., Brandt, K. D., Katz, B. P., Mazzuca, S. A., Braunstein, E. M., & Byrd, D. (1998). Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women?. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 41(11), 1951-1959.</p><p></p><p>Sol, A. O. P., Na, M. A. R., & Litoral, S. D. O. (2010). F Aculdade De M Otricidade H Umana Desporto , Turismo E Ambiente.</p><p></p><p>Steffen, T. M., Hacker, T. A & Mollinger, L. (2002). Age and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Physical Therapy, 82, 128137</p><p></p><p>Stover, A., Smith, C., Maloney, J., Mitchell, C., Michaels, N., Jones, T., & Raynes, E. (2015). AE for pain reduction in the active adult with osteoarthritis. The Journal of Aquatic Physical Therapy, 23(2), 13-19.</p><p></p><p>Sufka, K. J., & Price, D. D. (2002). Gate control theory reconsidered. Brain and</p><p>Mind, 3(2), 277-290.</p><p></p><p>Sundstrup, E., Jakobsen, M. D., Andersen, C. H., Bandholm, T., Thorborg, K., Zebis, M. K., & Andersen, L. L. (2014). Evaluation of elastic bands for lower extremity resistance training in adults with and without musculo-skeletal pain. Scandinavian Journal of Medicine and Science in Sports, 24(5), e353e359. https://doi.org/10.1111/sms.12187</p><p></p><p>Taaffe, D. R., Duret, C., Wheeler, S., & Marcus, R. (1999). Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. J.Am.Geriatr.Soc., 47, 12081214.</p><p></p><p>Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Boston, MA: Pearson.</p><p></p><p>Taglietti, M., Facci, L. M., Trelha, C. S., de Melo, F. C., da Silva, D. W., Sawczuk, G., Cardoso, J. R. (2018). Effectiveness of AEs compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial. Clinical Rehabilitation, 32(6), 766776. https://doi.org/10.1177/0269215517754240</p><p></p><p>Taiping Hospital - Google Maps. (n.d.). Retrieved from https://www.google.com/maps/place/Taiping+Hospital/@4.8510294,100.7368384,15z/data=!4m5!3m4!1s0x0:0x393e1cd9800d4d43!8m2!3d4.8510294!4d100.7368384</p><p></p><p>Tamin, T. Z., & Loekito, N. (2018). Aquatic versus land-based exercise for cardiorespiratory endurance and quality of life in obese patients with knee osteoarthritis : a randomized controlled trial. 27(4), 284292.</p><p></p><p>Tat, S. K., Lajeunesse, D., & Pelletier, J. (2017). Targeting subchondral bone for treating osteoarthritis : what is the evidence ? 24(1), 5170. https://doi.org/10.1016/j.berh.2009.08.004.Targeting</p><p></p><p>Teeli, S. M., & Kumar, A. (2019). A comparative study of physical Fitness components of basketball and handball players of Mewar University, Chittorgarh Rajasthan.</p><p></p><p>Thein, J. M., & Brody, L. T. (1998). Aquatic-based rehabilitation and training for the elite athlete. Journal of Orthopaedic & Sports Physical Therapy, 27(1), 32-41.</p><p></p><p>Theofanidis, D., & Fountouki, A. (2018). Limitations and delimitations in the research process. Perioperative nursing, 7(3), 155-163.</p><p>Thiyagarajan, S., & Christopher, J. D. (2013). Significance of Teaching Basic Physiotherapy Techniques to Non-Medical Workers in Rehabilitation Home or. Journal of Prevention & Treatment, 2(3), 3237. https://doi.org/10.5923/j.ijpt.20130203.02</p><p></p><p>Tick, H., Nielsen, A., Pelletier, K. R., Bonakdar, R., Simmons, S., Glick, R., Zador, V. (2018). Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore, 14(3), 177211. https://doi.org/10.1016/j.explore.2018.02.001</p><p></p><p>Timothy, K. (2016). Obesity and osteoarthritis. Maturitas. https://doi.org/10.1016/j.maturitas.2016.04.006</p><p></p><p>Timothy, A. (2020). Hydrotherapy aquatic physiotherapy and the application of bad ragaz ring method. Journal of Advanced Health Care, 2(II).</p><p></p><p>Tin, S. (2017). What Has Been Done to Tackle Overweight and Obesity in Malaysia ?: A Literature Review ( 2005 2015 ). 3, 5672.</p><p></p><p>Tognolo, L., Maccarone, M. C., De Trane, S., Scanu, A., Masiero, S., & Fiore, P. (2022). Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review. Medicina, 58(1), 69.</p><p></p><p>Topcu, Z. G., & lger, . (2017). Comparison of the effects of physiotherapy group exercise and basketball on quality of life of obese children. Open Journal of Therapy and Rehabilitation, 5(01), 1.</p><p></p><p>Topp, R., Woolley, S., Hornyak, J., Khuder, S., & Kahaleh, B. (2002). The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Archives of Physical Medicine and Rehabilitation, 83(9), 11871195. https://doi.org/10.1053/apmr.2002.33988</p><p></p><p>Tunay, V. B., Baltaci, G., & Atay, A. O. (2010). Hospital-based versus home-based proprioceptive and strengthening exercise program s in knee osteoarthritis. Acta Orthopaedica et Traumatologica Turcica, 44, 270277. https://doi.org/10.3944/AOTT.2010.2306</p><p></p><p>Uchida, M. C., Nishida, M. M., Sampaio, R. A. C., Moritani, T., & Arai, H. (2016). Thera-band elastic band tension: Reference values for physical activity. Journal of Physical Therapy Science, 28(4), 12661271. https://doi.org/10.1589/jpts.28.1266</p><p></p><p>Use, C. (2016). Stratification for Clinical Trials and Clinical Use. 23(8), 12331241. https://doi.org/10.1016/j.joca.2015.03.036.Call</p><p>Vaile, J., Halson, S., Gill, N., & Dawson, B. (2008). Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. European Journal of Applied Physiology, 102(4), 447455. https://doi.org/10.1007/s00421-007-0605-6</p><p></p><p>Veerapen, K., Wigley, R. D., & Valkenburg, H. (2007). Musculoskeletal pain in Malaysia: a COPCORD survey. The Journal of rheumatology, 34(1), 207-213.</p><p></p><p>Verhagen, A. P., Cardoso, J. R., & Bierma-Zeinstra, S. M. A. (2012). AE & balneotherapy in musculoskeletal conditions. Best Practice and Research: Clinical Rheumatology, 26(3), 335343. https://doi.org/10.1016/j.berh.2012.05.008</p><p></p><p>Vincent, H. K., Adams, M. C. B., Vincent, K. R., & Hurley, R. W. (2013). Musculoskeletal pain, fear avoidance behaviors, and functional decline in obesity potential interventions to manage pain and maintain function. Regional Anesthesia and Pain Medicine, 38(6), 481491. https://doi.org/10.1097/AAP.0000000000000013</p><p></p><p>Vincent, H. K., Heywood, K., Connelly, J., & Hurley, R. W. (2012). Obesity and Weight Loss in the Treatment and Prevention of Osteoarthritis. PM and R, 4(5 SUPPL.), S59S67. https://doi.org/10.1016/j.pmrj.2012.01.005</p><p></p><p>Vitaloni, M., Botto-van Bemden, A., Sciortino Contreras, R. M., Scotton, D., Bibas, M., Quintero, M., ... & Verges, J. (2019). Global management of patients with knee osteoarthritis begins with quality of life assessment: a systematic review. BMC musculoskeletal disorders, 20(1), 1-12.</p><p></p><p>Waller, B., & Benjamin. (2016). The effect of AE on symptoms, function, body composition and cartilage in knee osteoarthritis.</p><p></p><p>Wan Awatif, W. M. Z., Chan, S. C., Razainul Asikin, W., & WI, W. M. Z. (2019). Study On Health Related Quality Of Life Among Knee Osteoarthritis Patients. S. No. Title Page no., 2(1), 34.</p><p></p><p>Wang, S. Y., Olson-Kellogg, B., Shamliyan, T. A., Choi, J. Y., Ramakrishnan, R., & Kane, R. L. (2012). Physical therapy interventions for knee pain secondary to osteoarthritis: A systematic review. Annals of Internal Medicine, 157(9), 632644. https://doi.org/10.7326/0003-4819-157-9-201211060-00007</p><p></p><p>Wang, T., Lee, S., Liang, S., Tung, H., Wu, S. V, & Lin, Y. (2011). Comparing the efficacy of AEs and land-based exercises for patients with knee osteoarthritis. 26092622. https://doi.org/10.1111/j.1365-2702.2010.03675.x</p><p>Welling, A., & Nitsure, P. (2015a). Comparative Study Between Mat, Swiss Ball and Theraband Exercises on Abdominal Girth. International Journal of Physiotherapy and Research, 3(4), 11421149. https://doi.org/10.16965/ijpr.2015.158</p><p></p><p>Weinstein, L. B. (1986). The benefits of aquatic activity. Journal of Gerontological Nursing, 12(2), 6-9.</p><p>WHO. (2014). Towards tuberculosis elimination</p><p></p><p>Willis, L. H., Slentz, C. a, Bateman, L. a, Shields, a T., Piner, L. W., Bales, C. W., Kraus, W. E. (2012a). Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. Journal of Applied Physiology (Bethesda, Md. : 1985), 113, 18311837. https://doi.org/10.1152/japplphysiol.01370.2011</p><p></p><p>Wilmore, J. H., Costill, D. L. & Kenney, W. L. (2007). Physiology of Sport and Exercise. United State of America : Human Kinetics</p><p></p><p>Wluka, A. E., Lombard, C. B., & Cicuttini, F. M. (2013). Tackling obesity in knee osteoarthritis. Nature Reviews. Rheumatology, Vol. 9, pp. 225235. https://doi.org/10.1038/nrrheum.2012.224</p><p></p><p>Yi, S. S., Kwon, S. C., Wyatt, L., Islam, N., & Trinh-shevrin, C. (2015). Weighing in on the hidden Asian American obesity epidemic. Preventive Medicine, 73, 69. https://doi.org/10.1016/j.ypmed.2015.01.007</p><p></p><p>Yoo, J. H. (2020). The psychological effects of water-based exercise in older adults: an integrative review. Geriatric nursing, 41(6), 717-723.</p><p></p><p>Yusuf, E., Bijsterbosch, J., Slagboom, P. E., Rosendaal, F. R., Huizinga, T. W. J., & Kloppenburg, M. (2011). Body mass index and alignment and their interaction as risk factors for progression of knees with radiographic signs of osteoarthritis. Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society, 19(9), 11171122. https://doi.org/10.1016/j.joca.2011.06.001</p><p></p><p>Zakaria, Z. F., Bakar, A. A., Hasmoni, H. M., Rani, F. A., & Kadir, S. A. (2009). Health-related quality of life in patients with knee osteoarthritis attending two primary care clinics in Malaysia: A cross-sectional study. Asia Pacific Family Medicine, 8(1), 17. https://doi.org/10.1186/1447-056X-8-10</p><p></p><p>Zdziarski, L. A., Wasser, J. G., & Vincent, H. K. (2015). Chronic pain management in the obese patient: A focused review of key challenges and potential exercise solutions. Journal of Pain Research, 8, 6377.</p><p>https://doi.org/10.2147/JPR.S55360</p><p></p><p>Zeng, C., Li, H., Yang, T., Deng, Z. -h., Yang, Y., Zhang, Y., & Lei, G. -h. (2015). Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis and Cartilage, 23, 189202. https://doi.org/10.1016/j.joca.2014.11.014</p><p></p><p>Zhang, X., Pan, X., Deng, L., & Fu, W. (2020). Relationship between knee muscle strength and fat/muscle mass in elderly women with knee osteoarthritis based on dual-energy x-ray absorptiometry. International Journal of Environmental Research and Public Health, 17(2), 573.</p><p></p><p>Zhu, Z., Cui, L., Yin, M., Yu, Y., Zhou, X., Wang, H., & Yan, H. (2016). Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: A randomized controlled trial. Clinical Rehabilitation, 30(6), 587593. https://doi.org/10.1177/0269215515593392</p><p></p><p></p><p></p><p></p><p></p><p></p><p></p>