High-intensity versus low-intensity resistance training in patients with knee osteoarthritis: A randomized controlled trial

Abstract

Objectives To assess whether (i) high-intensity resistance training (RT) leads to increased muscle strength compared to low-intensity RT in patients with knee osteoarthritis (OA); and (ii) RT with vitamin D supplementation leads to increased muscle strength compared to placebo in a subgroup with vitamin D deficiency. Design Randomized controlled trial Setting Outpatient rehabilitation centre Subjects Patients with knee OA Interventions 12 weeks of RT at high-intensity RT (70–80% of 1-repetition maximum (1-RM)) or low-intensity RT (40–50% of 1-RM) and 24 weeks of vitamin D (1200 International units vitamin D3 per day) or placebo supplementation. Main measures Primary outcome measure was isokinetic muscle strength. Other outcome measure for muscle strength was the estimated 1-RM. Secondary outcome measures were knee pain and physical functioning. Results 177 participants with a mean age of 67.6 ± 5.8 years were included, of whom 50 had vitamin D deficiency. Isokinetic muscle strength (in Newton metre per kilogram bodyweight) at start, end and 24 weeks after the RT was 0.98 ± 0.40, 1.11 ± 0.40, 1.09 ± 0.42 in the high-intensity group and 1.02 ± 0.41, 1.15 ± 0.42, 1.12 ± 0.40 in the low-intensity group, respectively. No differences were found between the groups, except for the estimated 1-RM in favour of the high-intensity group. In the subgroup with vitamin D deficiency, no difference on isokinetic muscle strength was found between the vitamin D and placebo group. Conclusions High-intensity RT did not result in greater improvements in isokinetic muscle strength, pain and physical functioning compared to low-intensity RT in knee OA, but was well tolerated. Therefore these results suggest that either intensity of resistance training could be utilised in exercise programmes for patients with knee osteoarthritis. No synergistic effect of vitamin D supplementation and RT was found, but this finding was based on underpowered data.

Association Between Measures of Muscle Strength and Performance of Daily Activities in Patients with Knee Osteoarthritis

“…Patients’ characteristics at the start of RT are shown in Table I . Both isokinetic peak strength and estimated 1-RM improved over the 12 weeks of RT with 0.13 Nm/kg bodyweight and 0.27 kg/kg body weight, respectively (see Table I ) ( 17 ). Isokinetic peak strength and the estimated 1-RM were correlated at the start ( r = 0.516, p = 0.00) and end ( r = 0.533, p = 0.00) of the RT, but no correlation was found for the delta score ( r = –0.026, p = 0.754).…”

“…A full description of the RCT study design is given in the original manuscript (ViDEX RCT, under review) ( 17 ). The study protocol was approved by the Medical Ethics Review Board (Reade/Slotervaart hospital, NL47786.048.14) and was in compliance with the Declaration of Helsinki.…”

High-Intensity Interval Training for Knee Osteoarthritis: A Narrative Review

“…In the included studies, resistance training treatment duration ranged from six weeks to 18 months and was performed using different kinds of equipment. For instance, de Zwart et al [54], Thorstensson et al [57], Waller et al [58], and Messier et al [60] used resistance bands in their protocols, resulting in improvements in knee OA symptoms, muscle strength and physical functioning. Foroughi et al [55] and Jan et al [44] used machines such as leg press and leg extension/flexion, finding improvements in knee OA symptoms and muscle strength.…”

“…Three studies evaluated the outcomes of HIIT vs LIT for knee OA. One recent study by de Zwart et al [54] assessed whether resistance HIIT led to increased muscle strength compared to resistance LIT in patients with knee OA. One-hundred and seventy-seven participants were enrolled to a 12-week (3x/week) HIIT or LIT program.…”

The associations of knee extensor muscle steadiness with maximal voluntary torque and physical function in patients with knee osteoarthritis

“…A cross-sectional study was conducted using baseline data of patients who participated in the VIDEX randomized controlled trial (de Zwart et al, 2022). The VIDEX trial has been approved by the medical ethical committee (trial registration number, NL47786.048.14;EudraCT Number: 2014-000047-33).…”