Open Versus Closed Kinetic Chain: Exercise Effects on Center of Pressure and Y-Balance in Middle-Aged Women with Knee Osteoarthritis—A Randomized Controlled Trial

<b>Objective</b>: Head-to-head evidence comparing closed-kinetic-chain (CKC) and open-kinetic-chain (OKC) training on balance in middle-aged women with knee osteoarthritis (KOA) is limited. Purpose: To compare 10-week hip abduction/external rotation-focused CKC versus OKC on static and dynamic balance. <b>Methods</b>: Twenty-two women with KOA were randomized to CKC (n = 11) or OKC (n = 11) and trained twice weekly for 10 weeks. The primary outcome was the center of pressure (COP) during single-leg stance (AP/ML range, excursion, velocity, and RMS); the secondary outcome was the Y-Balance Test (YBT) composite score. <b>Results</b>: CKC produced significant within-group reductions across all COP variables and significant YBT increases for both affected and unaffected limbs (<i>p</i> < 0.05). OKC showed only small changes in select COP indices and no meaningful change in YBT. Post-intervention between-group comparisons consistently favored CKC for AP/ML and total COP excursion/velocity and for the YBT composite score (<i>p</i> < 0.05). <b>Conclusions</b>: Under weight-bearing conditions, a hip-focused CKC program that promotes multi-joint coordination and co-contraction yields broader and more consistent improvements in postural stability and dynamic balance than OKC in middle-aged women with KOA. These findings support prioritizing CKC when rehabilitation aims include gait and functional stability.