Efficacy of Blood Flow-Restricted Low-Load Resistance Training For Quadriceps Strengthening in Men at Risk of Symptomatic Knee Osteoarthritis

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2015 Sep 2

PMID 26328230

Citations 25

Authors

Neil Segal

Maria D Davis

Alan E Mikesky

Affiliations

Soon will be listed here.

Abstract

Background: Greater quadriceps strength has been associated with lower risk of symptomatic knee osteoarthritis (OA) in older adults. However, factors that confer elevated risk of knee OA (eg, sedentary lifestyle, obesity, and knee injury) also contribute to a reduced tolerance of resistance training programs at ≥60% 1-repetition maximum (1RM). Therefore, the current study assessed whether concurrent application of blood flow restriction (BFR) to low-load resistance training is an efficacious and tolerable means of improving quadriceps strength in men at risk of symptomatic knee OA.

Methods: Men older than age 45, with a history of knee injury or elevated body mass index (BMI), were randomized to low-load resistance training (30% 1RM) either with or without concurrent BFR. Isotonic double-leg press strength and isokinetic knee extensor strength were assessed before and after 4 weeks of training 3 times/wk. Knee pain (Knee Osteoarthritis Outcome Score) was assessed for tolerance.

Results: Of the 42 men (mean age 56.1 ± 7.7 years) who were randomized, 41 completed the program. There were no significant intergroup differences in age, BMI, knee pathology, or muscle strength at baseline. Although leg press 1RM improved in both control and BFR groups, there were no significant intergroup differences in primary or secondary measures of muscle strength. The BFR was not associated with worsening of knee pain, but there was a significant improvement in knee pain in the control group.

Conclusions: In comparison with training without BFR, addition of BFR to 30% 1RM resistance training for 4 weeks did not confer significantly greater increases in leg press or quadriceps strength in older men with risk factors for symptomatic knee OA.

Citing Articles

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References

Loenneke J, Wilson J, Marin P, Zourdos M, Bemben M . Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol. 2011; 112(5):1849-59. DOI: 10.1007/s00421-011-2167-x. View

Segal N, Glass N, Torner J, Yang M, Felson D, Sharma L . Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010; 18(6):769-75. PMC: 2873062. DOI: 10.1016/j.joca.2010.02.002. View

Gelber A, Hochberg M, Mead L, Wang N, Wigley F, Klag M . Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000; 133(5):321-8. DOI: 10.7326/0003-4819-133-5-200009050-00007. View

Labarbera K, Murphy B, Laroche D, Cook S . Sex differences in blood flow restricted isotonic knee extensions to fatigue. J Sports Med Phys Fitness. 2013; 53(4):444-52. View

Murphy L, Schwartz T, Helmick C, Renner J, Tudor G, Koch G . Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008; 59(9):1207-13. PMC: 4516049. DOI: 10.1002/art.24021. View

Petterson S, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L . Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc. 2008; 40(3):422-7. PMC: 3573845. DOI: 10.1249/MSS.0b013e31815ef285. View

Roos E, Lohmander L . The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003; 1:64. PMC: 280702. DOI: 10.1186/1477-7525-1-64. View

Segal N, Glass N, Felson D, Hurley M, Yang M, Nevitt M . Effect of quadriceps strength and proprioception on risk for knee osteoarthritis. Med Sci Sports Exerc. 2010; 42(11):2081-8. PMC: 2921020. DOI: 10.1249/MSS.0b013e3181dd902e. View

Cook S, Clark B, Ploutz-Snyder L . Effects of exercise load and blood-flow restriction on skeletal muscle function. Med Sci Sports Exerc. 2007; 39(10):1708-13. DOI: 10.1249/mss.0b013e31812383d6. View

10.

McAlindon T, Bannuru R, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S . OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014; 22(3):363-88. DOI: 10.1016/j.joca.2014.01.003. View

11.

Liu C, LaValley M, Latham N . Do unblinded assessors bias muscle strength outcomes in randomized controlled trials of progressive resistance strength training in older adults?. Am J Phys Med Rehabil. 2010; 90(3):190-6. DOI: 10.1097/PHM.0b013e31820174b3. View

12.

Roos E, Toksvig-Larsen S . Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003; 1:17. PMC: 161802. DOI: 10.1186/1477-7525-1-17. View

13.

Messier S, Mihalko S, Beavers D, Nicklas B, DeVita P, Carr J . Strength Training for Arthritis Trial (START): design and rationale. BMC Musculoskelet Disord. 2013; 14:208. PMC: 3722013. DOI: 10.1186/1471-2474-14-208. View

14.

Martin-Hernandez J, Marin P, Menendez H, Ferrero C, Loenneke J, Herrero A . Muscular adaptations after two different volumes of blood flow-restricted training. Scand J Med Sci Sports. 2013; 23(2):e114-20. DOI: 10.1111/sms.12036. View

15.

Nielsen J, Aagaard P, Bech R, Nygaard T, Grondahl Hvid L, Wernbom M . Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood flow restriction. J Physiol. 2012; 590(17):4351-61. PMC: 3473290. DOI: 10.1113/jphysiol.2012.237008. View

16.

Carroll T, Riek S, Carson R . Neural adaptations to resistance training: implications for movement control. Sports Med. 2001; 31(12):829-40. DOI: 10.2165/00007256-200131120-00001. View

17.

Pope Z, Willardson J, Schoenfeld B . Exercise and blood flow restriction. J Strength Cond Res. 2013; 27(10):2914-26. DOI: 10.1519/JSC.0b013e3182874721. View

18.

Iida H, Kurano M, Takano H, Kubota N, Morita T, Meguro K . Hemodynamic and neurohumoral responses to the restriction of femoral blood flow by KAATSU in healthy subjects. Eur J Appl Physiol. 2007; 100(3):275-85. DOI: 10.1007/s00421-007-0430-y. View

19.

Segal N, Williams G, Davis M, Wallace R, Mikesky A . Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis. PM R. 2014; 7(4):376-84. PMC: 4385750. DOI: 10.1016/j.pmrj.2014.09.014. View

20.

Baker K, Xu L, Zhang Y, Nevitt M, Niu J, Aliabadi P . Quadriceps weakness and its relationship to tibiofemoral and patellofemoral knee osteoarthritis in Chinese: the Beijing osteoarthritis study. Arthritis Rheum. 2004; 50(6):1815-21. DOI: 10.1002/art.20261. View