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▎Knee arthritis, editor of WuXi AppTec's content team, affects more than 250 million people worldwide.
Based on effective evidence from clinical trials, clinical guidelines recommend that patients with knee arthritis undergo strength training to relieve pain and improve muscle strength.
However, the strength training intensity in previous randomized trials was low, and the intervention time was also short.
In contrast, can high-intensity strength training reduce pain and improve knee pressure, or will it aggravate knee arthritis symptoms? The Journal of the American Medical Association recently published a randomized controlled trial, which brought us new and important evidence.
Screenshot source: JAMA This study comes from a research team from the Department of Health and Exercise Science at Wake Forest University, which evaluated the effects of low-intensity training and high-intensity training on knee arthritis.
A total of 320 subjects were included and finally completed the trial.
These subjects were ≥50 years of age, had a body mass index (BMI) between 20 and 45, had symptoms of knee joint pain, and had knee arthritis confirmed by imaging studies.
The subjects who completed the experiment were randomly received high-intensity strength training (109 cases), low-intensity strength training (108 cases) or attention control (103 cases, control group) training for 18 months.
Strength training 3 times a week, 1 hour each time, including 6 types of lower limb exercises, 4 types of upper limb and core exercises (comprehensive rowing, chest, lower back and abdominal training).
The weight for high-intensity training is controlled at 75%-90% of the maximum loadable weight, and the weight for low-intensity training is controlled at 30%-40% of the maximum loadable weight.
Re-evaluate the patient's maximum loadable weight every 9 weeks and adjust the training intensity accordingly.
Patients in the attention control group received a total of 24 group discussion sessions, each for 60 minutes.
Image source: The primary endpoint of the 123RF trial is the patient's self-reported knee pain (assessed by WOMAC index [0 best-20 most severe]) and the maximum knee pressure during walking.
During the 18-month follow-up, after adjusting gender, body mass index, and baseline arthritis degree, the data showed that the high-intensity strength training group and the low-intensity strength training group (5.
1 points vs 4.
4 points, P = 0.
08), and high-intensity strength training There was no statistical difference in WOMAC scores for knee joint pain between the group and the control group (5.
1 points vs 4.
9 points, P = 0.
61).
There was no significant difference in knee joint pressure between the high-intensity strength training group and the other two groups (high-intensity 2453N vs low-intensity 2475N, p=0.
85, high-intensity 2453N vs control group 2512N, P=0.
61).
▲There was no significant difference in knee joint pain and knee pressure in the three test groups (other factors were not adjusted) (picture source: reference [1]) The knee muscle strength of the two strength training groups was significantly higher at 18 months Compared with the control group, there is no significant difference between the high-intensity and low-intensity groups.
At the same time, imaging data showed that compared with the natural history of osteoarthritis, high-intensity strength training did not aggravate disease progression.
The research team pointed out that in this trial, the control group received stronger training and interaction, which improved compliance.
Through attention control, the knee arthritis pain in the control group improved by 33%, which may also be compared with high-intensity strength training.
One of the reasons for the insignificant difference from the control group.
The research team also pointed out that the study used musculoskeletal models to estimate knee pressure, which may be limited by simplified assumptions.
There were 87 cases of non-serious adverse events (53 cases in the high-intensity group; 30 cases in the low-intensity group; 4 cases in the control group) and 13 cases of serious adverse events not related to the study (5 cases in the high-intensity group; 3 cases in the low-intensity group).
; 5 cases in the control group). Based on these findings, the research team believes that compared to low-intensity strength training or attention control training, high-intensity strength training for 18 months did not significantly reduce knee pain or knee pressure.
Adult patients with knee arthritis do not support low-intensity training.
Strength training or attention control training is changed to high-intensity strength training.
Related reading JAMA sub-news: Can people at high risk of knee arthritis run and exercise? A 10-year study found that "uncommon sense" NEJM: To improve the pain and function of knee arthritis, which one is better than physical therapy and hormone therapy? References [1] Messier SP, Mihalko SL, Beavers DP, et al.
, (2021).
Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial.
JAMA , DOI: 10.
1001/jama.
2021.
0411 [2] High-intensity strength training no added benefit for knee osteoarthritis.
Retrieved February 23, 2021, from https://medicalxpress.
com/news/2021-02-high-intensity-strength- added-benefit-knee.
html Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.
If you need guidance on treatment plans, please go to a regular hospital for treatment.
Based on effective evidence from clinical trials, clinical guidelines recommend that patients with knee arthritis undergo strength training to relieve pain and improve muscle strength.
However, the strength training intensity in previous randomized trials was low, and the intervention time was also short.
In contrast, can high-intensity strength training reduce pain and improve knee pressure, or will it aggravate knee arthritis symptoms? The Journal of the American Medical Association recently published a randomized controlled trial, which brought us new and important evidence.
Screenshot source: JAMA This study comes from a research team from the Department of Health and Exercise Science at Wake Forest University, which evaluated the effects of low-intensity training and high-intensity training on knee arthritis.
A total of 320 subjects were included and finally completed the trial.
These subjects were ≥50 years of age, had a body mass index (BMI) between 20 and 45, had symptoms of knee joint pain, and had knee arthritis confirmed by imaging studies.
The subjects who completed the experiment were randomly received high-intensity strength training (109 cases), low-intensity strength training (108 cases) or attention control (103 cases, control group) training for 18 months.
Strength training 3 times a week, 1 hour each time, including 6 types of lower limb exercises, 4 types of upper limb and core exercises (comprehensive rowing, chest, lower back and abdominal training).
The weight for high-intensity training is controlled at 75%-90% of the maximum loadable weight, and the weight for low-intensity training is controlled at 30%-40% of the maximum loadable weight.
Re-evaluate the patient's maximum loadable weight every 9 weeks and adjust the training intensity accordingly.
Patients in the attention control group received a total of 24 group discussion sessions, each for 60 minutes.
Image source: The primary endpoint of the 123RF trial is the patient's self-reported knee pain (assessed by WOMAC index [0 best-20 most severe]) and the maximum knee pressure during walking.
During the 18-month follow-up, after adjusting gender, body mass index, and baseline arthritis degree, the data showed that the high-intensity strength training group and the low-intensity strength training group (5.
1 points vs 4.
4 points, P = 0.
08), and high-intensity strength training There was no statistical difference in WOMAC scores for knee joint pain between the group and the control group (5.
1 points vs 4.
9 points, P = 0.
61).
There was no significant difference in knee joint pressure between the high-intensity strength training group and the other two groups (high-intensity 2453N vs low-intensity 2475N, p=0.
85, high-intensity 2453N vs control group 2512N, P=0.
61).
▲There was no significant difference in knee joint pain and knee pressure in the three test groups (other factors were not adjusted) (picture source: reference [1]) The knee muscle strength of the two strength training groups was significantly higher at 18 months Compared with the control group, there is no significant difference between the high-intensity and low-intensity groups.
At the same time, imaging data showed that compared with the natural history of osteoarthritis, high-intensity strength training did not aggravate disease progression.
The research team pointed out that in this trial, the control group received stronger training and interaction, which improved compliance.
Through attention control, the knee arthritis pain in the control group improved by 33%, which may also be compared with high-intensity strength training.
One of the reasons for the insignificant difference from the control group.
The research team also pointed out that the study used musculoskeletal models to estimate knee pressure, which may be limited by simplified assumptions.
There were 87 cases of non-serious adverse events (53 cases in the high-intensity group; 30 cases in the low-intensity group; 4 cases in the control group) and 13 cases of serious adverse events not related to the study (5 cases in the high-intensity group; 3 cases in the low-intensity group).
; 5 cases in the control group). Based on these findings, the research team believes that compared to low-intensity strength training or attention control training, high-intensity strength training for 18 months did not significantly reduce knee pain or knee pressure.
Adult patients with knee arthritis do not support low-intensity training.
Strength training or attention control training is changed to high-intensity strength training.
Related reading JAMA sub-news: Can people at high risk of knee arthritis run and exercise? A 10-year study found that "uncommon sense" NEJM: To improve the pain and function of knee arthritis, which one is better than physical therapy and hormone therapy? References [1] Messier SP, Mihalko SL, Beavers DP, et al.
, (2021).
Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial.
JAMA , DOI: 10.
1001/jama.
2021.
0411 [2] High-intensity strength training no added benefit for knee osteoarthritis.
Retrieved February 23, 2021, from https://medicalxpress.
com/news/2021-02-high-intensity-strength- added-benefit-knee.
html Note: This article aims to introduce the progress of medical and health research, not a treatment plan recommendation.
If you need guidance on treatment plans, please go to a regular hospital for treatment.
