The Effectiveness of Thai Exercise with Traditional Massage on the Pain, Walking Ability and QOL of Older People with Knee Osteoarthritis: A Randomized Controlled Trial in the Community Punnee Peungsuwan1, 2)*, Phawinee Sermcheep 1, 2), Papatsara Harnmontree1, 2), Wichai Eungpinichpong1, 2), Rungthip Puntumetakul1, 2), Uraiwan Chatchawan1, 2), Junichiro Yamauchi3, 4) 1) School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mitraphab Highway, Muang District, Khon Kaen 40002, Thailand 2) Back, Neck and Other Joint Pain Research Group, Khon Kaen University, Thailand 3) Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan 4) Future Institute for Sport Sciences, Japan Abstract. [Purpose] This study investigated the effectiveness of a class- and home-based exercise with massage between Thai traditional and standardized physical therapy (TPT and SPT) in older people with knee osteoarthritis (KOA). [Subjects and Methods] Thirty-one subjects with KOA (aged 50–85 years) in two selected villages were randomly assigned into the TPT or SPT programs. Seventeen TPT subjects received Thai exercise with traditional massage, and 14 SPT individuals performed strengthening exercise with Swedish massage. Both programs consisted of a class with supervision plus home self-care for 8 weeks; the subjects then managed home self-care for 1 year. [Results] After 2 months, the six-minute walk test (6MWT), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and SF-36 testing showed significant improvement in both groups, but the improvement of the TPT group was greater. After 1year, only the score for the 6MWT was greater in the TPT group than in the SPT group. [Conclusion] The TPT program yielded better results for the 6MWT, but, both programs had beneficial effects on the pain, function, and QOL of middle-aged and older patients with KOA in the community setting. Key words: Knee osteoarthritis, Six-minute walk test, Bodyweight-based exercise training (This article was submitted Jun. 25, 2013, and was accepted Aug. 25, 2013) INTRODUCTION Knee osteoarthritis (KOA) is the most common joint disease in middle-aged and older people. Pain is the main symptom that leads to limitation in the patients’ abilities such as the ability to walk, stand up, and climb stairs, and dependency in daily living activities1) . This disease leads to poor quality of life (QOL) and is a significant burden on health-care services2) . The primary goal of treatment in KOA is reducing pain and improving functional capacity3) . Non-pharmacological treatment, physical therapy (PT), and complementary and alternative medicine (CAM), which includes massage4) , alternative exercise5) , thermotherapy6) , and acupuncture7) , play an important role in health care for patients with KOA. The use of CAM in developed countries appears to be increasing as awareness increases. It may have been that use of CAM increased with socioeconomic status8) . Currently, alternative exercises including yoga, Tai Chi, and aquatic programs are models of exercise therapy for patients with KOA5, 9, 10) . Strengthening and aerobic exercise are beneficial for improving KOA-related symptoms in terms of pain11) and physical function12) . In Thailand, a form of Thai exercise that utilizes a wand is popular among elderly people and is a body weight-based form of resistance exercise; however, the intensity of this exercise can be increased by lifting the wand in upper limb exercise or can be decreased by using the wand to support the body. Our previous study shows that Thai exercise with a wand can improve QOL13) . This exercise with a wand tends to increase muscle strength, which can be beneficial for pain improvement; however, the evidence regarding this is not clear. This exercise might be a better therapeutic form for reducing pain in KOA patients when combined with Thai massage because it has been shown to reduce the pain in patients with back pain14) and scapulocostal syndrome15) . Home- and class-based programs are some of the most suitable treatments for elderly people in the community16) . Nonetheless, a previous study found that patients carried out a home-based program just for the initial phase and subsequently did not maintain a self-care program17) . Thereby, J. Phys. Ther. Sci. 26: 139–144, 2014 *Corresponding author. Punnee Peungsuwan (e-mail: ppunne@kku.ac.th) ©2014 The Society of Physical Therapy Science This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-ncnd) License . 140 J. Phys. Ther. Sci. Vol. 26, No. 1, 2014 a home-based program along with a class-based program supervised by physical therapists might provide confidence for patients to help in management of knee symptoms by themselves. However, there is no evidence concerning whether or not Thai exercise with traditional massage can effect the pain, walking ability, and QOL in patients with KOA. Thus, the aim of this study was to investigate the effectiveness of a class- and home-based program