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Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis


Medicine & Science in Sports & Exercise: May 2018 - Volume 50 - Issue 5 - p 897–905
doi: 10.1249/MSS.0000000000001530
Clinical Sciences

Purpose Evaluate the effects of a low-intensity resistance training (LI-RT) 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: LI-RT (30% one repetition maximum [1-RM]) associated (blood flow restriction training [BFRT]) or not (LI-RT) with partial blood flow restriction, and high-intensity resistance training (HI-RT, 80% 1-RM). Patients underwent a 12-wk supervised training program and were assessed for lower-limb 1-RM, quadriceps cross-sectional area, functionality (timed-stands test and timed-up-and-go test), and disease-specific inventory (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) before (PRE) and after (POST) the protocol.

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 cross-sectional area (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. The BFRT and HI-RT showed comparable improvements in timed-stands test (7% and 14%, respectively), with the latter showing greater increases than LI-RT. Timed-up-and-go test 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 (of 16) were excluded due to exercise-induced knee pain in HI-RT.

Conclusions Blood flow restriction training 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.

1Applied Physiology and Nutrition Research Group - School of Physical Education and Sport, University of São Paulo, SP, BRAZIL; and 2Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, University of São Paulo, SP, BRAZIL

Address for correspondence: Hamilton Roschel, Ph.D., Escola de Educação Física e Esporte – Universidade de São Paulo, Av. Melo de Moraes, 65, Butantã, São Paulo 05508-030, Brazil; E-mail:

Submitted for publication August 2017.

Accepted for publication December 2017.

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© 2018 American College of Sports Medicine