# Impact of combined balance and strength exercise program on lower limb energy flow in individuals with knee osteoarthritis

**Authors:** Ponthep Tangkanjanavelukul, Nattapat Khumtong, Khemchat Chaemklan, Dipak Kumar Agrawal, Pornthep Rachnavy

PMC · DOI: 10.3389/fspor.2025.1661125 · 2025-10-09

## TL;DR

A six-month balance and strength exercise program improved lower limb energy flow and reduced symptoms in people with knee osteoarthritis.

## Contribution

The study demonstrates that a combined balance and strength training program improves biomechanics and reduces symptoms in knee osteoarthritis.

## Key findings

- Participants showed significant improvements in WOMAC scores for pain, stiffness, and physical function.
- Energy flow analysis revealed enhanced hip and ankle energy dynamics and reduced knee energy absorption.
- The program suggests potential for personalized rehabilitation and fall prevention in knee osteoarthritis patients.

## Abstract

Knee osteoarthritis disrupts biomechanical energy flow, resulting in joint instability, impaired movement, and pain. These issues impact daily activities and increase the risk of falls. Effective interventions are essential.

This study examined the effects of a six-month balance and strength training program on lower limb biomechanics and self-reported outcomes in individuals with mild to moderate knee osteoarthritis.

Twenty-three participants (mean age: 62.4 years; 69.57% female) completed a structured balance and strength exercise program three times per week. Gait analysis was used to assess lower limb energy flow, while the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measured symptoms before and after the intervention.

Significant improvements were observed in overall WOMAC scores (p = 0.009), including subscales for pain (p = 0.022), stiffness (p = 0.005), and physical function (p = 0.013). Energy flow analysis revealed increased energy inflow and outflow at the hip (p < 0.001), reduced energy absorption at the knee (p < 0.001), and enhanced energy outflow at the ankle (p < 0.001), suggesting improved gait dynamics.

The combined balance and strength exercise program effectively enhanced lower limb biomechanics and reduced knee osteoarthritis symptoms. Energy flow analysis may support personalized rehabilitation approaches and help identify individuals at elevated fall risk.

This exercise program improved lower limb biomechanics, reduced pain and stiffness, enhanced energy flow, and may optimize rehabilitation and fall prevention in individuals with knee osteoarthritis.

## Full-text entities

- **Diseases:** falls (MESH:C537863), pain (MESH:D010146), impaired movement (MESH:D009069), stiffness (MESH:C566112), Osteoarthritis (MESH:D010003), Knee osteoarthritis (MESH:D020370), joint instability (MESH:D007593)

## Figures

5 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12546085/full.md

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Source: https://tomesphere.com/paper/PMC12546085