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Effect of low-intensity resistance training with blood flow restriction on functional status in knee osteoarthritis

  • Alvita Sari ,
  • I Putu Alit Pawana ,
  • Ditaruni Asrina Utami ,
  • Soenarnatalina Melaniani ,

Abstract

Background: Knee osteoarthritis is a joint pathology with high prevalence, resulting from the increase of aging and obesity in the world population. Articular cartilage destruction can cause pain and eventually reduces activities of daily living and affects functional status in subjects with knee osteoarthritis. Exercise interventions in knee-OA aimed at increasing knee extensor muscle strength involve high-intensity resistance training but may result in joint pain due to high-compressive forces. Other alternative method includes low-intensity resistance training performed with blood flow restriction, a potential intervention for a patient who does not tolerate high loads due to lower mechanical stress. This study aims to determine the effects of blood flow restriction with low-intensity resistance training on the quadriceps for six weeks on functional status in knee-OA patients.

Methods: Twenty-eight patients aged 50-70 years old with knee-OA in Physical Medicine and Rehabilitation Outpatient Clinic Soetomo Hospital Surabaya were randomized into control and treatment groups. Both groups underwent a 6-week supervised training program consisting of LI-RT (30% 1-RM) two sessions/week. The treatment group received an additional application of blood flow restriction using a cuff on 1/3 of the upper thigh with 50 mmHg occlusion pressure. Both groups were assessed for functional status by self-reported WOMAC questionnaire before and after the protocol.

Results: Both training methods were able to reduce WOMAC pain and improve physical function subscales significantly, but WOMAC stiffness subscales only reduced significantly in low-intensity resistance training with blood flow restriction. There were no significant differences between groups for any domain from WOMAC, nor any significant differences between delta scores (all P > 0.05).

Conclusion: Low-intensity resistance training with and without blood flow restriction was similarly effective in enhancing functional status in subjects with knee osteoarthritis.

References

  1. Narasinta I, Masduchi RH, Kurniawati PM. Immediate Effect of Kinesio Taping Application on Joint Proprioception Function in Knee Osteoarthritis Patients. Surabaya Phys Med Rehabil J. 2019;1(1):1. https://doi.org/10.20473/spmrj.v1i1.2019.1-5
  2. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020 Feb;72(2):220-233. https://doi.org/10.1002/art.41142.
  3. Jardim RAC, de Sousa TS, dos Santos WNN, Matos AP, Iosimuta NCR. Blood flow restriction with different load levels in patients with knee osteoarthritis: protocol of a randomized controlled trial. Trials. 2022;23(1):1-13. https://doi.org/10.1186/s13063-022-05998-3.
  4. Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020 Nov 26;29-30:100587. https://doi.org/10.1016/j.eclinm.2020.100587.
  5. Muraki S, Oka H, Akune T, et al. Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: The ROAD study. Osteoarthr Cartil. 2009;17(9):1137-1143. https://doi.org/10.1016/j.joca.2009.04.005.
  6. Hafez AR, Mohammed A. Knee Osteoarthritis: A Review of Literature Physical Medicine and Rehabilitation - Knee Osteoarthritis : A Review of Literature. Phys Med Rehabil Int. 2018;1(5):8. p1-9.
  7. Arden N, Blanco FJ, Bruyère O, Al. E. Atlas of Osteoarthritis. Second Edition. British Library Cataloguing-in-Publication Data. Springer Healthcare. 2018. p1-110.
  8. Mahmoud WS, Elnaggar RK, Ahmed AS, Mahmoud WS. Influence of Isometric Exercise Training on Quadriceps Muscle Architecture and Strength in Obese Subjects with Knee Osteoarthritis. 2017;6(3). p1-9.
  9. Rice DA, McNair PJ, Lewis GN. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: The effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects. Arthritis Res Ther. 2011;13(5):R151. https://doi.org/10.1186/ar3467.
  10. Ikeda S, Tsumura H, Torisu T. Age-related quadriceps-dominant muscle atrophy and incident radiographic knee osteoarthritis. J Orthop Sci. 2005;10(2):121-126. https://doi.org/10.1007/s00776-004-0876-2.
  11. Abdallah MM, Fayaz MA, and Mohammed MM. Effect of Low Load Resistance Blood Flow Restriction Training on Knee Osteoarthritis. Med J Cairo Univ. 2018;86(12):4297-4306. https://doi.org/10.21608/mjcu.2018.62817.
  12. Pitsillides A, Stasinopoulos D, Mamais I. Blood flow restriction training in patients with knee osteoarthritis: Systematic review of randomized controlled trials. J Bodyw Mov Ther. 2021;27:477-486. https://doi.org/10.1016/j.jbmt.2021.04.015.
  13. Pringga GA, Andriana RAM, Wardhani IL, Arfianti L. Comparison of Hamstrings and Quadriceps Femoris Muscle Thickness Increment between Agonist-Antagonist Paired Set and Traditional Set Resistance Training in Untrained Healthy Subjects. Surabaya Phys Med Rehabil J. 2021;3(2):60. https://doi.org/10.20473/spmrj.v3i2.20976.
  14. Ferlito JV, Pecce SAP, Oselame L, De Marchi T. The blood flow restriction training effect in knee osteoarthritis people: a systematic review and meta-analysis. Clin Rehabil. 2020;34(11):1378-1390. https://doi.org/10.1177/0269215520943650.
  15. Gujral T, Lachyan A. Blood Flow Restriction Combined with Kinaesthesia, Balance Training for Osteoarthritis Knee: A Rare Case Report. Int J Sci Healthc Res. 2021;6(2):139-146. https://doi.org/10.52403/ijshr.20210425.
  16. Bryk FF, dos Reis AC, Fingerhut D, et al. Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial. Knee Surgery, Sport Traumatol Arthrosc. 2016;24(5):1580-1586. https://doi.org/10.1007/s00167-016-4064-7.
  17. Amorim S, Alexandra P, Hans D, and Luciana DNJ. The effects of blood flow restriction exercise on vascular function in the elderly: A systematic review. Integr Clin Med. 2019;3(1):1-6. https://doi.org/10.15761/icm.1000140.
  18. Gajwani GH, Borkar P. High Resistance Verses Low Resistance Training on Pain in Patients with Knee Osteoarthritis. Int J Heal Sci Res. 2017;7(12). p91-98.
  19. Cerqueira MS, De Brito Vieira WH. Effects of blood flow restriction exercise with very low load and low volume in patients with knee osteoarthritis: Protocol for a randomized trial. Trials. 2019;20(1):1-9. https://doi.org/10.1186/s13063-019-3238-2.
  20. Karsten S, Limena S, Phandu M. Translation, adaptation, and validation of western ontario and mcmaster universities osteoarthritis index (WOMAC) for indonesian. J Orthop dan Traumatol Indones. 2019;2(3). p17-26. https://doi.org/10.31282/joti.v2n3.48.
  21. Ferraz RB, Gualano B, Rodrigues R, Kurimori CO, Fuller R, Lima FR, DE Sá-Pinto AL, Roschel H. Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis. Med Sci Sports Exerc. 2018 May;50(5):897-905. https://doi.org/10.1249/MSS.0000000000001530.
  22. Althubaiti A. Sample size determination: A practical guide for health researchers. J Gen Fam Med. 2022;24(2). p72-78. https://doi.org/10.1002/jgf2.600.
  23. Harper SA, Roberts LM, Layne AS, et al. Blood-flow restriction resistance exercise for older adults with knee osteoarthritis: A pilot randomized clinical trial. J Clin Med. 2019;8(2). https://doi.org/10.3390/jcm8020265.
  24. Krishnasamy P, Hall M, Robbins SR. The role of skeletal muscle in the pathophysiology and management of knee osteoarthritis. Rheumatol (United Kingdom). 2018;57(January):iv22-iv33. https://doi.org/10.1093/rheumatology/kex515.
  25. Hughes L, Patterson SD. Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect. Med Hypotheses. 2019;132:109370. https://doi.org/10.1016/j.mehy.2019.109370.
  26. Ruhdorfer A, Wirth W, Eckstein F. Association of knee pain with a reduction in thigh muscle strength – a cross-sectional analysis including 4553 osteoarthritis initiative participants. Osteoarthr Cartil. 2017;25(5):658-666. https://doi.org/10.1016/j.joca.2016.10.026.
  27. Bartholdy C, Juhl C, Christensen R, Lund H, Zhang W, Henriksen M. The role of muscle strengthening in exercise therapy for knee osteoarthritis: A systematic review and meta-regression analysis of randomized trials. Semin Arthritis Rheum. 2017;03(007). https://doi.org/10.1016/j.semarthrit.
  28. Gandek B. Measurement Properties of the Western Ontario and McMaster Universities Osteoarthritis Index: A Systematic Review. Arthritis Care Res (Hoboken). 2015;67(2):216-229. https://doi.org/10.1002/acr.22415.
  29. Serrão PRMS, Gramani-Say K, Lessi GC, Mattiello SM. Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function. Brazilian J Phys Ther. 2012;16(4):289-294. https://doi.org/10.1590/s1413-35552012005000031.
  30. Kim MJ, Kang BH, Park SH, et al. Association of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) with Muscle Strength in Community-Dwelling Elderly with Knee Osteoarthritis. IJERPH. 2020;17(7):2260. https://doi.org/10.3390/ijerph17072260.
  31. Cotofana S, Wirth W, Pena Rossi C, Eckstein F, Günther OH. Contralateral Knee Effect on Self-Reported Knee-Specific Function and Global Functional Assessment: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2015;67(3):374-381. https://doi.org/10.1002/acr.22495.
  32. Turner MN, Hernandez DO, Cade W, Emerson CP, et al. The Role of Resistance Training Dosing on Pain and Physical Function in Individuals With Knee Osteoarthritis: A Systematic Review. Sports Health. 2020;12(2). p200-206. https://doi.org/10.1177/1941738119887183.
  33. Petersson N, Jørgensen SL, Kjeldsen T, Mechlenburg I, Aagaard P. Blood Flow Restricted Walking In Elderly Individuals With Knee Osteoarthritis: A Feasibility Study. J Rehabil Med. Published online 2022. https://doi.org/10.2340/jrm.v54.2163.
  34. Segal N, Davis MD, Mikesky AE. Efficacy of Blood Flow-Restricted Low-Load Resistance Training For Quadriceps Strengthening in Men at Risk of Symptomatic Knee Osteoarthritis. Geriatr Orthop Surg Rehabil. 2015;6(3):160-167. https://doi.org/10.1177/2151458515583088.
  35. Rodriguez-Lopez C, Beckwée D, Luyten FP, Van Assche D, Van Roie E. Reduced knee extensor torque production at low to moderate velocities in postmenopausal women with knee osteoarthritis. Scand J Med Sci Sport. 2021;31(11):2144-2155. https://doi.org/10.1111/sms.14035.
  36. Cook SB, LaRoche DP, Villa MR, Barile H, Manini TM. Blood flow restricted resistance training in older adults at risk of mobility limitations. Exp Gerontol. 2017;99:138-145. https://doi.org/10.1016/j.exger.2017.10.004.
  37. De Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. J Rehabil Med. 2018;50(2):140-150. https://doi.org/10.2340/16501977-2284.
  38. Vieira de Melo RF, Komatsu WR, Freitas MS de, Vieira de Melo ME, Cohen M. Comparison of Quadriceps and Hamstring Muscle Strength after Exercises with and without Blood Flow Restriction following Anterior Cruciate Ligament Surgery: A Randomized Controlled Trial. J Rehabil Med. 2022;54(3):jrm00337. https://doi.org/10.2340/jrm.v54.2550.
  39. Martin PM, Bart RM, Ashley RL, Velasco T, Wise SR. An Overview of Blood Flow Restriction Physiology and Clinical Considerations. Curr Sports Med Rep. 2022;21(4):123-128. https://doi.org/10.1249/JSR.0000000000000948.
  40. Sumide T, Sakuraba K, Sawaki K, Ohmura H, Tamura Y. Effect of resistance exercise training combined with relatively low vascular occlusion. J Sci Med Sport. 2009;12(1):107-112. https://doi.org/10.1016/j.jsams.2007.09.009.
  41. Kubota A, Sakuraba K, Koh S, Ogura Y, Tamura Y. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport. 2011;14(2):95-99. https://doi.org/10.1016/j.jsams.2010.08.007.
  42. Fahs CA, Rossow LM, Loenneke JP, et al. Effect of different types of lower body resistance training on arterial compliance and calf blood flow. Clin Physiol Funct Imaging. 2012;32(1):45-51. https://doi.org/10.1111/j.1475-097X.2011.01053.x.
  43. Cardoso RK, Araujo AM, de Freitas MP, Rombaldi AJ. Effect of training with partial blood flow restriction in older adults: A systematic review. Rev Bras Cineantropometria e Desempenho Hum. 2018;20(2):219-228. https://doi.org/10.5007/1980-0037.2018v20n2p219.
  44. Kemnitz J, Wirth W, Eckstein F, Culvenor AG. The role of thigh muscle and adipose tissue in knee osteoarthritis progression in women: data from the Osteoarthritis Initiative. Osteoarthr Cartil. 2018;26(9):1190-1195. https://doi.org/10.1016/j.joca.2018.05.020.
  45. Cerqueira MS, Costa EC, Santos Oliveira R, Pereira R, Brito Vieira WH. Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period? Front Physiol. 2021;12(June):1-11. https://doi.org/10.3389/fphys.2021.678407.

How to Cite

Sari, A., Pawana, I. P. A., Utami, D. A., & Melaniani, S. (2023). Effect of low-intensity resistance training with blood flow restriction on functional status in knee osteoarthritis. Bali Medical Journal, 12(3), 2604–2611. https://doi.org/10.15562/bmj.v12i3.4683

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Alvita Sari
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I Putu Alit Pawana
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Ditaruni Asrina Utami
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Soenarnatalina Melaniani
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