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Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis.

ABSTRACT: To assess whether concurrent blood flow restriction (BFR) during low-load resistance training is an efficacious and tolerable means of improving quadriceps strength and volume in women with risk factors for symptomatic knee osteoarthritis (OA).Randomized, double-blinded, controlled trial.Exercise training clinical research laboratory.Women over age 45 years with risk factors for symptomatic knee OA.Participants were randomized to either low-load resistance training (30% 1RM) alone (control) or with concurrent BFR and completed 4 weeks of 3 times per week leg-press resistance training. Those randomized to BFR wore a cuff that progressively restricted femoral blood flow over the weeks of training. Intergroup differences in outcome measures were compared using regression methods, while adjusting for BMI.Isotonic bilateral leg press strength, isokinetic knee extensor strength, and quadriceps volume by magnetic resonance imaging were assessed before and after participation. Secondary measures included lower limb muscle power (leg press and stair climb). Knee pain was assessed to determine tolerance.Of 45 women who consented to study participation, 40 completed the program. There were no significant intergroup differences in baseline characteristics except that body mass index was lower in the BFR group (P = .0223). Isotonic 1RM improved significantly more in the BFR group (28.3 ± 4.8 kg) than in the control group (15.6 ± 4.5 kg) (P = .0385). Isokinetic knee extensor strength scaled to body mass increased significantly more in the BFR group (0.07 ± 0.03 nm/kg) than in the control group (-0.05 ± 0.03 nm/kg) (P = .0048). Changes in quadriceps volume, leg press power, and knee-related pain did not significantly differ between groups.Addition of BFR to a 30% 1RM resistance training program was effective in increasing leg press and knee extensor strength in women at risk for knee OA, in comparison with the same program without BFR.

SUBMITTER: Segal NA

PROVIDER: S-EPMC4385750 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis.

Segal Neil A NA Williams Glenn N GN Davis Maria C MC Wallace Robert B RB Mikesky Alan E AE

PM & R : the journal of injury, function, and rehabilitation 20141005 4

<h4>Objective</h4>To assess whether concurrent blood flow restriction (BFR) during low-load resistance training is an efficacious and tolerable means of improving quadriceps strength and volume in women with risk factors for symptomatic knee osteoarthritis (OA).<h4>Design</h4>Randomized, double-blinded, controlled trial.<h4>Setting</h4>Exercise training clinical research laboratory.<h4>Participants</h4>Women over age 45 years with risk factors for symptomatic knee OA.<h4>Methods</h4>Participants ...[more]

PMID: 25289840

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Project description:INTRODUCTION:Up to 20% of patients undergoing total knee replacement (TKR) surgery report no or suboptimal pain relief after TKR. Moreover, despite chances of recovering to preoperative functional levels, patients receiving TKR have demonstrated persistent deficits in quadriceps strength and functional performance compared with healthy age-matched adults. We intend to examine if low-load blood flow restricted exercise (BFRE) is an effective preoperative method to increase functional capacity, lower limb muscle strength and self-reported outcomes after TKR. In addition, the study aims to investigate to which extent preoperative BFRE will protect against surgery-related atrophy 3?months after TKR. METHODS:In this multicentre, randomised controlled and assessor blinded trial, 84 patients scheduled for TKR will be randomised to receive usual care and 8?weeks of preoperative BFRE or to follow usual care-only. Data will be collected before randomisation, 3-4?days prior to TKR, 6?weeks, 3?months and 12 months after TKR. Primary outcome will be the change in 30?s chair stand test from baseline to 3-month follow-up. Key secondary outcomes will be timed up and go, 40 me fast-paced walk test, isometric knee extensor and flexor strength, patient-reported outcome and selected myofiber properties.Intention-to-treat principle and per-protocol analyses will be conducted. A one-way analysis of variance model will be used to analyse between group mean changes. Preintervention-to-postintervention comparisons will be analysed using a mixed linear model. Also, paired Student's t-test will be performed to gain insight into the potential pretraining-to-post-training differences within the respective training or control groups and regression analysis will be used for analysation of associations between selected outcomes. ETHICAL APPROVAL:The trial has been accepted by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 10-72-19-19) and the Danish Data Protection Agency (Journal No 652164). All results will be published in international peer-reviewed scientific journals regardless of positive, negative or inconclusive results. TRIAL REGISTRATION NUMBER:NCT04081493.

Project description:The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ? 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05) improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid-point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach for persons with knee OA.

Project description:Purpose: It is well established that high-load resistance exercise (HLRE) can stimulate myofibrillar accretion. Additionally, recent studies suggest that HLRE can also stimulate mitochondrial biogenesis and respiratory function. However, in several clinical situations, the use of resistance exercise with high loading may not constitute a viable approach. Low-load blood flow restricted resistance exercise (BFRRE) has emerged as a time-effective low-load alternative to stimulate myofibrillar accretion. It is unknown if BFRRE can also stimulate mitochondrial biogenesis and respiratory function. If so, BFRRE could provide a feasible strategy to stimulate muscle metabolic health. Methods: To study this, 34 healthy previously untrained individuals (24 ± 3 years) participated in BFRRE, HLRE, or non-exercise control intervention (CON) 3 times per week for 6 weeks. Skeletal muscle biopsies were collected; (1) before and after the 6-week intervention period to assess mitochondrial biogenesis and respiratory function and; (2) during recovery from single-bout exercise to assess myocellular signaling events involved in transcriptional regulation of mitochondrial biogenesis. During the 6-week intervention period, deuterium oxide (D2O) was continuously administered to the participants to label newly synthesized skeletal muscle mitochondrial proteins. Mitochondrial respiratory function was assessed in permeabilized muscle fibers with high-resolution respirometry. Mitochondrial content was assessed with a citrate synthase activity assay. Myocellular signaling was assessed with immunoblotting. Results: Mitochondrial protein synthesis rate was higher with BFRRE (1.19%/day) and HLRE (1.15%/day) compared to CON (0.92%/day) (P < 0.05) but similar between exercise groups. Mitochondrial respiratory function increased to similar degree with both exercise regimens and did not change with CON. For instance, coupled respiration supported by convergent electron flow from complex I and II increased 38% with BFRRE and 24% with HLRE (P < 0.01). Training did not alter citrate synthase activity compared to CON. BFRRE and HLRE elicited similar myocellular signaling responses. Conclusion: These results support recent findings that resistance exercise can stimulate mitochondrial biogenesis and respiratory function to support healthy skeletal muscle and whole-body metabolism. Intriquingly, BFRRE produces similar mitochondrial adaptations at a markedly lower load, which entail great clinical perspective for populations in whom exercise with high loading is untenable.

Project description:BackgroundThe effectiveness of blood flow restriction training (BFR) in elderly with knee osteoarthritis (OA) is comparable to performing high-intensity protocols (70 to 80% of 1 RM [repetition maximum]) that are known to be effective for improving the muscle strength of knee extensors, with the advantage of generating less particular rating of perceived exertion and pain immediately after training. However, despite being a promising alternative, little is known about the best way to apply the BFR, such as level of pressure and combination or not with other therapeutic modalities. The purpose of this study is to evaluate whether different levels of blood flow restriction with low load (BFR + LL) and no load (BFR + rest) are non-inferior to high-intensity resistance exercise (HIRE+BFRplacebo) for pain reduction in patients with knee OA.Methods/designThis clinical trial is a non-inferiority, five-arm, randomized, active-controlled, single trial which will be carried out in 165 patients of both sexes with knee OA, aged 50 years and older. Participants will be randomly allocated into 5 exercise groups (40% of BFR + LL; 80% of BFR + LL; 40% of BFR + rest; 80% BFR + rest, and HIRE+BFR placebo). A mixed linear model will be used to examine the effect of group-by-time interaction on pain intensity on the WOMAC subscale (primary outcome) and on disease severity, physical functional data, balance data, quality of life, global perceived effect scale, and muscle strength (secondary outcomes). Participants will be analyzed for intention-to-treat, and the statistical assessor blinded to the groups. The collection of outcomes 72 h after completion of the 16 weeks of interventions will be the primary measurement point. Follow-up secondary timepoints will be collected at 20, 28, 40, 52, and 64 weeks after the end of interventions, except for pain during the training, which will be measured immediately at the end of each session. Only the comparison of the primary outcome between the HIRE group with each BFR group will be analyzed in the non-inferiority framework, the other comparisons between the BFR groups for the primary outcome, and all secondary outcomes will be interpreted in the superiority framework.DiscussionThe results of this clinical trial can point out more clearly to ways to optimize the BFR training with the minimum of pain immediately after training, which will allow the offer of an effective and more adherent strengthening training to patients with knee OA.Trial registrationRegistro Brasileiro de Ensaios Clínicos, RBR-93rx9q . Registered on 23 July 2020. Version 1.0.

Dataset Information

Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis.

Publications

Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis.

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