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Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis

Ferraz, Rodrigo Branco2; Gualano, Bruno1,2; Rodrigues, Reynaldo1; Kurimori, Ceci Obara1; Fuller, Ricardo1; Lima, Fernanda Rodrigues1; de Sá-Pinto, Ana Lúcia1; Roschel, Hamilton1,2

doi: 10.1249/MSS.0000000000001530
Clinical Investigation/Case Study: PDF Only

Purpose Evaluate the effects of a low-intensity resistance training program associated with partial blood flow restriction on selected clinical outcomes in patients with knee osteoarthritis (OA).

Methods Forty-eight women with knee OA were randomized into one of the three groups: low-intensity resistance training (30% one repetition maximum 1-RM) associated (BFRT) or not (LI-RT) with partial blood flow restriction, and high-intensity resistance training (HI-RT: 80% 1-RM). Patients underwent a 12-week supervised training program and were assessed for lower-limb 1-RM, quadriceps cross-sectional area (CSA), functionality (timed-stands test - TST and timed-up-and-go test - TUG), and disease-specific inventory (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC) before (PRE) and after the protocol (POST).

Results Similar within-group increases were observed in leg-press (26% and 33%, all p<0.0001), knee-extension 1-RM (23% and 22%; all p<0.0001) and CSA (7% and 8%; all p<0.0001) in BFRT and HI-RT, respectively, and these were significantly greater (all p<0.05) than those of LI-RT. BFRT and HI-RT showed comparable improvements in TST (7% and 14%, respectively), with the latter showing greater increases than LI-RT. TUG scores were not significantly changed within or between groups. WOMAC physical function was improved in BFRT and HI-RT (-49% and -42%, respectively; all p<0.05), and WOMAC pain was improved in BFRT and LI-RT (-45% and -39%, respectively; all p<0.05). Four patients (out of 16) were excluded due to exercise-induced knee pain in HI-RT.

Conclusion BFRT and HI-RT were similarly effective in increasing muscle strength, quadriceps muscle mass, and functionality in knee OA patients. Importantly, BFRT was also able to improve pain while inducing less joint stress, emerging as a feasible and effective therapeutic adjuvant in OA management. KEY-WORDS: Arthritis; cartilage; rehabilitation; WOMAC; hypoxia; KAATSU.

1Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, SP, Brazil

2Applied Physiology and Nutrition Research Group - School of Physical Education and Sport, University of São Paulo, SP, Brazil

Corresponding Author: Dr. Hamilton Roschel, Ph.D. Escola de Educação Física e Esporte – Universidade de São Paulo, Av. Melo de Moraes, 65, Butantã – São Paulo, SP - Brazil, Postal code: 05508-030, E-mail:

Disclosure of funding received for this work: Fundação do Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Pesquisa e Desenvolvimento (CNPq). The authors declare that they have no competing interests. The results of the present study do not constitute endorsement by ACSM. The results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Accepted for Publication: 14 December 2017

© 2018 American College of Sports Medicine