Effects of internet of things-based ergometer cycling and quadriceps strengthening on joint stiffness, function and walking ability in patients with knee osteoarthritis_West China Medical Journal

Authors：

QI Yue ^1,2 , ZHU Linsen ^1,2 , WANG Xiaoyi ³ ,  HE Chengqi ^1,2

1. Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Jiangsu Province Xuzhou Technician Institute, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

HE Chengqi, Email: hxkfhcq2015@126.com

Keywords：

Knee osteoarthritis; ergometer cycling; quadriceps strengthening; knee dysfunction

DOI：

10.7507/1002-0179.202504219

Video：

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Objective To investigate the effects of ergometer cycling training based on the internet of things and quadriceps strengthening based on internet mobile phones on joint stiffness, function and walking ability in patients with knee osteoarthritis (KOA) in a community setting. Methods KOA patients attending West China Hospital, Sichuan University were selected between April and July 2022. The patients were randomly divided into ergometer cycling group, quadriceps strengthening group and control group (treated with traditional therapy) using a random number table method. The patient underwent a 12 week intervention. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, Timed Up and Go Test (TUG) were used to evaluate the degree of joint stiffness, joint function and walking ability of patients. Data was collected and evaluated before intervention and at 4, 8, and 12 weeks after the initial intervention.Results A total of 72 patients were included, with 24 cases in each group. There were interactive effects between group and time in WOMAC joint stiffness score, joint functional score and TUG test time (P<0.05). At 8 and 12 weeks after intervention, the joint stiffness scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group. At 4, 8 and 12 weeks after intervention, the joint function scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group (P<0.05). At 8, 12 weeks after intervention, the TUG test scores of the ergometer cycling group were better than those of the control group and the quadriceps strengthening group (P<0.05). Conclusions In a community setting, both 12-week Internet of thing-based ergometer cycling and internet video-based quadriceps strengthening were effective on improving knee stiffness and function in KOA patients and were superior to traditional methods, the two effects were comparable. Ergometer cycling is superior to quadriceps strengthening and traditional methods in improving walking ability.

Citation： QI Yue, ZHU Linsen, WANG Xiaoyi, HE Chengqi. Effects of internet of things-based ergometer cycling and quadriceps strengthening on joint stiffness, function and walking ability in patients with knee osteoarthritis. West China Medical Journal, 2025, 40(6): 865-869. doi: 10.7507/1002-0179.202504219 Copy

1.	Hua J, Sun L, Teng Y. Effects of high-intensity strength training in adults with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Phys Med Rehabil, 2023, 102(4): 292-299.
2.	Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA, 2021, 325(6): 568-578.
3.	Lan X, Li L, Jia Q, et al. Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis. Aging Clin Exp Res, 2025, 37(1): 121.
4.	Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019, 27(11): 1578-1589.
5.	Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum, 2019, 49(3): 337-350.
6.	中国老年保健协会骨关节分会. 早期膝骨关节炎诊断与非手术治疗指南(2024 版). 中华医学杂志, 2024, 104(31): 2895-2909.
7.	Mangione KK, McCully K, Gloviak A, et al. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci, 1999, 54(4): M184-M190.
8.	Kus G, Yeldan I. Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis. Rheumatol Int, 2019, 39(2): 203-218.
9.	Dobson F, Bennell KL, French SD, et al. Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis: synthesis of the literature using behavior change theory. Am J Phys Med Rehabil, 2016, 95(5): 372-389.
10.	Mbada CE, Awosika HA, Sonuga OA, et al. Effect of clinic-based and asynchronous video-based exercise on clinic and psychosocial outcomes in patients with knee osteoarthritis: quasi-experimental study. J Med Internet Res, 2025, 27: e58393.
11.	Dias JF, Oliveira VC, Borges P, et al. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med, 2021, 55(3): 155-162.
12.	Wang Y, Lombard C, Hussain SM, et al. Effect of a low-intensity, self-management lifestyle intervention on knee pain in community-based young to middle-aged rural women: a cluster randomised controlled trial. Arthritis Res Ther, 2018, 20(1): 74.
13.	Wang HN, Luo P, Liu S, et al. Effectiveness of internet-based telehealth programs in patients with hip or knee osteoarthritis: systematic review and meta-analysis. J Med Internet Res, 2024, 26: e55576.
14.	Xie SH, Wang Q, Wang LQ, et al. Effect of internet-based rehabilitation programs on improvement of pain and physical function in patients with knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Med Internet Res, 2021, 23(1): e21542.
15.	朱林森, 王小逸, 何成奇. 基于物联网的功率自行车训练和股四头肌训练对膝骨关节炎患者疼痛和生活质量的影响. 华西医学, 2025, 40(1): 48-54.
16.	中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心 (湘雅医院), 等. 中国骨关节炎诊疗指南(2021 年版). 中华骨科杂志, 2021, 41(18): 24.
17.	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
18.	Lim BW, Hinman RS, Wrigley TV, et al. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum, 2008, 59(7): 943-951.
19.	Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982, 14(5): 377-381.
20.	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
21.	Clement ND, Bardgett M, Weir D, et al. What is the minimum clinically important difference for the WOMAC index after TKA?. Clin Orthop Relat Res, 2018, 476(10): 2005-2014.
22.	Sabet F, Ebrahimipour E, Anbarian M. Plantar pressure distribution patterns during gait and functional mobility in early-stage knee osteoarthritis: a comparative study. Musculoskeletal Care, 2025, 23(1): e70049.
23.	Uesugi Y, Koyanagi J, Takagi K, et al. Exercise Therapy interventions in patients with hip osteoarthritis: comparison of the effects of DVD and website-based interventions. JMIR Rehabil Assist Technol, 2018, 5(1): e10.
24.	Dobkin BH. A rehabilitation-internet-of-things in the home to augment motor skills and exercise training. Neurorehabil Neural Repair, 2017, 31(3): 217-227.
25.	Chen Q, Wu X, Huang Y, et al. Internet of Things-Based Home Respiratory Muscle Training for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. Int J Chron Obstruct Pulmon Dis, 2024, 19: 1093-1103.
26.	石秀秀, 郭全义, 赵宁, 等. 基于物联网的脉冲磁疗联合运动疗法对膝骨关节炎的远程康复疗效观察. 中国骨与关节杂志, 2024, 13(4): 260-266.
27.	Akgül H, Birtane M, Tonga E. Effects of a digitally supported physical activity intervention in knee osteoarthritis: a pilot randomized controlled trial. Musculoskeletal Care, 2025, 23(2): e70085.
28.	Karasavvidis T, Hirschmann MT, Kort NP, et al. Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations. J Exp Orthop, 2020, 7(1): 52.
29.	Rewald S, Lenssen AFT, Emans PJ, et al. Aquatic cycling improves knee pain and physical functioning in patients with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil, 2020, 101(8): 1288-1295.
30.	Alkatan M, Baker JR, Machin DR, et al. Improved function and reduced pain after swimming and cycling training in patients with osteoarthritis. J Rheumatol, 2016, 43(3): 666-672.
31.	Oliveira AM, Peccin MS, Silva KN, et al. Impact of exercise on the functional capacity and pain of patients with knee osteoarthritis: a randomized clinical trial. Rev Bras Reumatol, 2012, 52(6): 876-882.
32.	Bischoff HA, Roos EM. Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis. Curr Opin Rheumatol, 2003, 15(2): 141-144.
33.	Thomas KS, Muir KR, Doherty M, et al. Home based exercise programme for knee pain and knee osteoarthritis: randomized controlled trial. BMJ, 2002, 325(7367): 752.
34.	Ahmad MA, Yusof A, Hamid M, et al. Effects of self-management program as adjunctive to usual rehabilitation exercise on pain and functional outcomes in knee osteoarthritis: a randomized controlled trial. J Res Health Sci, 2023, 23(1): e00569.
35.	Øiestad BE, Årøen A, Røtterud JH, et al. The efficacy of strength or aerobic exercise on quality of life and knee function in patients with knee osteoarthritis. A multi-arm randomized controlled trial with 1-year follow-up. BMC Musculoskelet Disord, 2023, 24(1): 714.

1. Hua J, Sun L, Teng Y. Effects of high-intensity strength training in adults with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Phys Med Rehabil, 2023, 102(4): 292-299.
2. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA, 2021, 325(6): 568-578.
3. Lan X, Li L, Jia Q, et al. Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis. Aging Clin Exp Res, 2025, 37(1): 121.
4. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019, 27(11): 1578-1589.
5. Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum, 2019, 49(3): 337-350.
6. 中国老年保健协会骨关节分会. 早期膝骨关节炎诊断与非手术治疗指南(2024 版). 中华医学杂志, 2024, 104(31): 2895-2909.
7. Mangione KK, McCully K, Gloviak A, et al. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci, 1999, 54(4): M184-M190.
8. Kus G, Yeldan I. Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis. Rheumatol Int, 2019, 39(2): 203-218.
9. Dobson F, Bennell KL, French SD, et al. Barriers and facilitators to exercise participation in people with hip and/or knee osteoarthritis: synthesis of the literature using behavior change theory. Am J Phys Med Rehabil, 2016, 95(5): 372-389.
10. Mbada CE, Awosika HA, Sonuga OA, et al. Effect of clinic-based and asynchronous video-based exercise on clinic and psychosocial outcomes in patients with knee osteoarthritis: quasi-experimental study. J Med Internet Res, 2025, 27: e58393.
11. Dias JF, Oliveira VC, Borges P, et al. Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations. Br J Sports Med, 2021, 55(3): 155-162.
12. Wang Y, Lombard C, Hussain SM, et al. Effect of a low-intensity, self-management lifestyle intervention on knee pain in community-based young to middle-aged rural women: a cluster randomised controlled trial. Arthritis Res Ther, 2018, 20(1): 74.
13. Wang HN, Luo P, Liu S, et al. Effectiveness of internet-based telehealth programs in patients with hip or knee osteoarthritis: systematic review and meta-analysis. J Med Internet Res, 2024, 26: e55576.
14. Xie SH, Wang Q, Wang LQ, et al. Effect of internet-based rehabilitation programs on improvement of pain and physical function in patients with knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Med Internet Res, 2021, 23(1): e21542.
15. 朱林森, 王小逸, 何成奇. 基于物联网的功率自行车训练和股四头肌训练对膝骨关节炎患者疼痛和生活质量的影响. 华西医学, 2025, 40(1): 48-54.
16. 中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心 (湘雅医院), 等. 中国骨关节炎诊疗指南(2021 年版). 中华骨科杂志, 2021, 41(18): 24.
17. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
18. Lim BW, Hinman RS, Wrigley TV, et al. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum, 2008, 59(7): 943-951.
19. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982, 14(5): 377-381.
20. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
21. Clement ND, Bardgett M, Weir D, et al. What is the minimum clinically important difference for the WOMAC index after TKA?. Clin Orthop Relat Res, 2018, 476(10): 2005-2014.
22. Sabet F, Ebrahimipour E, Anbarian M. Plantar pressure distribution patterns during gait and functional mobility in early-stage knee osteoarthritis: a comparative study. Musculoskeletal Care, 2025, 23(1): e70049.
23. Uesugi Y, Koyanagi J, Takagi K, et al. Exercise Therapy interventions in patients with hip osteoarthritis: comparison of the effects of DVD and website-based interventions. JMIR Rehabil Assist Technol, 2018, 5(1): e10.
24. Dobkin BH. A rehabilitation-internet-of-things in the home to augment motor skills and exercise training. Neurorehabil Neural Repair, 2017, 31(3): 217-227.
25. Chen Q, Wu X, Huang Y, et al. Internet of Things-Based Home Respiratory Muscle Training for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. Int J Chron Obstruct Pulmon Dis, 2024, 19: 1093-1103.
26. 石秀秀, 郭全义, 赵宁, 等. 基于物联网的脉冲磁疗联合运动疗法对膝骨关节炎的远程康复疗效观察. 中国骨与关节杂志, 2024, 13(4): 260-266.
27. Akgül H, Birtane M, Tonga E. Effects of a digitally supported physical activity intervention in knee osteoarthritis: a pilot randomized controlled trial. Musculoskeletal Care, 2025, 23(2): e70085.
28. Karasavvidis T, Hirschmann MT, Kort NP, et al. Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations. J Exp Orthop, 2020, 7(1): 52.
29. Rewald S, Lenssen AFT, Emans PJ, et al. Aquatic cycling improves knee pain and physical functioning in patients with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil, 2020, 101(8): 1288-1295.
30. Alkatan M, Baker JR, Machin DR, et al. Improved function and reduced pain after swimming and cycling training in patients with osteoarthritis. J Rheumatol, 2016, 43(3): 666-672.
31. Oliveira AM, Peccin MS, Silva KN, et al. Impact of exercise on the functional capacity and pain of patients with knee osteoarthritis: a randomized clinical trial. Rev Bras Reumatol, 2012, 52(6): 876-882.
32. Bischoff HA, Roos EM. Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis. Curr Opin Rheumatol, 2003, 15(2): 141-144.
33. Thomas KS, Muir KR, Doherty M, et al. Home based exercise programme for knee pain and knee osteoarthritis: randomized controlled trial. BMJ, 2002, 325(7367): 752.
34. Ahmad MA, Yusof A, Hamid M, et al. Effects of self-management program as adjunctive to usual rehabilitation exercise on pain and functional outcomes in knee osteoarthritis: a randomized controlled trial. J Res Health Sci, 2023, 23(1): e00569.
35. Øiestad BE, Årøen A, Røtterud JH, et al. The efficacy of strength or aerobic exercise on quality of life and knee function in patients with knee osteoarthritis. A multi-arm randomized controlled trial with 1-year follow-up. BMC Musculoskelet Disord, 2023, 24(1): 714.

West China Medical Journal

Effects of internet of things-based ergometer cycling and quadriceps strengthening on joint stiffness, function and walking ability in patients with knee osteoarthritis

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