Effects of Creatine Supplementation in Addition to Resistance Exercise Training in Patients With Knee Osteoarthritis

• Lower Extremity Resistance Exercise Training (Other), also known as Lower Extremity Strength Training: Treadmill walking 5-10 min for warm up Strength training: (80% of 8RM) 3 times supervised exercise for 4 weeks Warm up (Self Paced walking for 10 minutes) leg press, leg extension, Sit to stand squat (mini squats) Stationary Cycling (Maximum Resistance as per patient tolerance till failure) 3 sets 8 reps 10-15 s rep rest interval 1-2 min set rest interval
• Home Exercise Plan (Other): 2 sets of 10 repetitions/day of AROM isolated knee extension and knee flexion Isometric isolated knee extension and knee flexion Isometric terminal knee extension Sit to stand squat Isometric knee terminal extension
• Electrotherapy + Heating (Device): Interferential Current therapy (2P), in combination with heating pad for 20 minutes
• Joint Mobilization (Procedure), also known as Manual Therapy: Tibio-femoral Anterior Glide Tibio-femoral Posterior Glide Patellofemoral Joint Mobilization
• Creatine Supplementation (Dietary supplement): Creatine Supplementation 20g/day for 1 week followed by 5 g/day for 3 weeks

Primary outcomes

• Knee Pain: Visual Analogue Scale [2 weeks]: Visual Analogue Scale was used to measure pain scoring from 0-10 cm on a horizontal 10cm line. A greater score reflects higher pain intensity.
• Knee Pain: Visual Analogue Scale [4 weeks]: Visual Analogue Scale was used to measure pain scoring from 0-10 cm on a horizontal 10cm line. A greater score reflects higher pain intensity.
• Knee Range of Motion [2 weeks]: Knee Range of Motion will be quantified by using Gonimeter
• Knee Range of Motion [4 weeks]: Knee Range of Motion will be quantified by using Gonimeter
• Knee Isometric Muscle Strength [2 weeks]: Knee Isometric Muscle Strength will be quantified by using Modified Sphygmomanometer Dynamometer
• Knee Isometric Muscle Strength [4 weeks]: Knee Isometric Muscle Strength will be quantified by using Modified Sphygmomanometer Dynamometer
• Six Minute Walk Test [2 weeks]: Six Minute Walk Test will be used to quantify walking related performance fatigability, walking distance and walking speed.
• Six Minute Walk Test [4 weeks]: Six Minute Walk Test will be used to quantify walking related performance fatigability, walking distance and walking speed.
• 5 repetition sit to stand test [2 weeks]: Time will be measured to perform 5 repetitions of sit to stand activity. Lesser time means a better score.
• 5 repetition sit to stand test [4 weeks]: Time will be measured to perform 5 repetitions of sit to stand activity. Lesser time means a better score.

Secondary outcomes

• Knee Injury and Osteoarthritis Outcome Score (KOOS) [2 weeks]: Knee Injury and Osteoarthritis Outcome Score (KOOS) to measure physical function and quality of life. A greater score on Knee Injury and Osteoarthritis Outcome Score reflects good prognosis and outcome and a lower score shows poor prognosis and outcome. the score for Knee Injury and Osteoarthritis Outcome Score is reported in the form of percentage i.e. 0-100%.
• Knee Injury and Osteoarthritis Outcome Score (KOOS) [4 weeks]: Knee Injury and Osteoarthritis Outcome Score (KOOS) to measure physical function and quality of life. A greater score on Knee Injury and Osteoarthritis Outcome Score reflects good prognosis and outcome and a lower score shows poor prognosis and outcome. the score for Knee Injury and Osteoarthritis Outcome Score is reported in the form of percentage i.e. 0-100%.
• Body Composition [2 weeks]: Body Composition was measured via bioelectrical impedance analysis. A greater Phase angle reflects better cellular integrity and smaller phase angle reflects poorer cellular integrity.
• Body Composition [4 weeks]: Body Composition was measured via bioelectrical impedance analysis. A greater Phase angle reflects better cellular integrity and smaller phase angle reflects poorer cellular integrity.
• Fall Risk [2 weeks]: Fall risk will be quantified by using Biodex balance System
• Fall Risk [4 weeks]: Fall risk will be quantified by using Biodex balance System

Sex: All, ages: 40 Years to 70 Years

Inclusion Criteria:

* Age 40-70 years
* Knee OA with history not less than three months.
* Radiological evidences of grade III or less on Kellgren classification.
* Knee pain on VNRS no more than 8/10

Exclusion Criteria:

* Neuromuscular conditions that may lead to fatigue such as multiple Sclerosis
* Signs of serious pathology (e.g., malignancy, inflammatory disorder, infection).
* History of trauma or fractures in lower extremity.
* Signs of lumbar radiculopathy or myelopathy.
* History of knee surgery or replacement.
* Patients on intra-articular steroid therapy within two months before the commencement of the study.
* Impaired skin sensation.
* Impaired renal function

• Muhammad Osama, PhD*, Principal investigator, Foundation University Institute of Rehabilitation Sciences