Frontiers in Sports and Active Living · Oct 9, 2025

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

By Tangkanjanavelukul P, Khumtong N, Chaemklan K et al.

INTRODUCTION: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSION: 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.

doi.org/10.3389/fspor.2025.1661125Open accessPubMed 41140925Interventions