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Eccentric and Concentric Resistance Exercise Comparison for Knee Osteoarthritis


Medicine & Science in Sports & Exercise: October 2019 - Volume 51 - Issue 10 - p 1977–1986
doi: 10.1249/MSS.0000000000002010

Introduction This study aimed to compare the efficacy of eccentrically focused resistance exercise (ECC RT) to concentrically focused resistance exercise (CNC RT) on knee osteoarthritis (OA) symptoms and strength.

Methods Ninety participants consented. Participants were randomized to CNC RT, ECC RT, or a wait-list, no-exercise control group. Four months of supervised exercise training was completed using traditional weight machines (CNC RT) or modified-matched machines that overloaded the eccentric action (ECC RT). Main outcomes included one-repetition maximal strength (knee extension, leg flexion, and leg press), weekly rate of strength gain, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) total score and subscores.

Results Fifty-four participants (60–85 yr, 61% women) completed the study. Both CNC RT and ECC RT groups showed 16%–28% improvement relative to the wait-list, no-exercise control group (P = 0.003–0.005) for all leg strength measures. The rate of weekly strength gain was greater for CNC RT than for ECC RT for leg press and knee flexion (by 2.9%–4.8%; both, P < 0.05) but not knee extension (0.7%; P = 0.38). There were no significant differences in WOMAC total and subscores across groups over time. Leg press strength change was the greatest contributor to change in WOMAC total scores (R2 = 0.223). The change in knee flexion strength from baseline to month 4 was a significant predictor of the change in WOMAC pain subscore (F ratio = 4.84, df = 45, P = 0.032). Both modes of strength training were well tolerated.

Conclusions Both resistance training types effectively increased leg strength. Knee flexion and knee extension muscle strength can modify function and pain symptoms irrespective of muscle contraction type. Which mode to pick could be determined by preference, goals, tolerance to the contraction type, and equipment availability.

1Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL

2Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL

Address for correspondence: Kevin R. Vincent, M.D., Ph.D., Department of Orthopedics and Rehabilitation, Division of Research, UF Orthopaedics and Sports Medicine Institute, PO Box 112727, Gainesville, FL 32611; E-mail:

Submitted for publication September 2018.

Accepted for publication April 2019.

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Online date: April 26, 2019

© 2019 American College of Sports Medicine