Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial

Abstract

BackgroundQuadriceps femoris muscle (QFM) weakness is a feature of knee osteoarthritis (OA) and exercise programs that strengthen this muscle group can improve function, disability and pain. Traditional supervised resistance exercise is however resource intensive and dependent on good adherence which can be challenging to achieve in patients with significant knee OA. Because of the limitations of traditional exercise programs, interest has been shown in the use of neuromuscular electrical stimulation (NMES) to strengthen the QFM. We conducted a single-blind, prospective randomized controlled study to compare the effects of home-based resistance training (RT) and NMES on patients with moderate to severe knee OA.Methods41 patients aged 55 to 75 years were randomised to 6 week programs of RT, NMES or a control group receiving standard care. The primary outcome was functional capacity measured using a walk test, stair climb test and chair rise test. Additional outcomes were self-reported disability, quadriceps strength and cross-sectional area. Outcomes were assessed pre- and post-intervention and at 6 weeks post-intervention (weeks 1, 8 and 14 respectively).ResultsThere were similar, significant improvements in functional capacity for the RT and NMES groups at week 8 compared to week 1 (p≤0.001) and compared to the control group (p < 0.005), and the improvements were maintained at week 14 (p≤0.001). Cross sectional area of the QFM increased in both training groups (NMES: +5.4%; RT: +4.3%; p = 0.404). Adherence was 91% and 83% in the NMES and RT groups respectively (p = 0.324).ConclusionsHome-based NMES is an acceptable alternative to exercise therapy in the management of knee OA, producing similar improvements in functional capacity. Trial registration: Current Controlled Trials ISRCTN85231954

Efeitos de oito semanas de treinamento com estimulação elétrica neuromuscular nas razões de ativação muscular / torque de idosas com osteoartrite

“…In addition, the results of this study partly corroborate those of Bruce-Brand et al, 20 which identified improved functional ability and reduced pain after eight weeks of training with artificial electrical stimulation. However, these authors found no significant increase in isometric torque after eight weeks of training, a finding which differs from the results of the present study, in which there was a significant increase in isometric torque at the training angle after NMES training.…”

“…However, these authors found no significant increase in isometric torque after eight weeks of training, a finding which differs from the results of the present study, in which there was a significant increase in isometric torque at the training angle after NMES training. These results may be related to the lower training time per-session and maintenance of the same training parameters for every session, without changing volume and intensity, used by Bruce-Brand et al, 20 compared to the present study. 16,21,22 In contrast, the present study conducted NMES training with only one knee flexion angle (90°), which resulted in increased torque after the training period solely for this angle, representing a possible limitation of the study.…”

Phisical modalities on the functional performance in knee osteoarthritis: a sytematic review

“…Scientific evidences used in this review show that the neuromuscular electrical stimulation (NMES) may be beneficial in patients with knee OA in variables such as pain (6,(23)(24)(25)(26), physical function (6,23,25), functional performance (25,27), discomfort (6), daily living activities (6) and stiffness (23,25). Furthermore, NMES seems to compensate physiological declines occurring in the muscle of patients, acting both in structure as in function of the quadriceps (23) by means of cross-sectional area increases (23,27) and muscular strength (23,25) and also in the improvement of voluntary muscle activation when combined with an exercise program (24).…”

“…Furthermore, NMES seems to compensate physiological declines occurring in the muscle of patients, acting both in structure as in function of the quadriceps (23) by means of cross-sectional area increases (23,27) and muscular strength (23,25) and also in the improvement of voluntary muscle activation when combined with an exercise program (24). The parameters used in these studies (6,(23)(24)(25)(26)(27) varied from: 50-80Hz, 100-400μs, intensity: visible muscle contraction until the maximum tolerated, time on: 10 seconds, off time: 10-50 seconds 15-45 minutes per session, for 12-36 sessions.…”

Effectiveness of Exercise Therapy and its Variations in Lower Limb Osteoarthritis: A Literature Review

“…Table 1 summarizes the findings from randomized controlled trials on exercise and allied therapies in OA conducted in the last 5 years. [14][15][16][17]26,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] …”