The use of a single resistance exercise with or without blood flow restriction in the treatment of pain in knee osteoarthritis: a randomized clinical trial
A utilização de um único exercício resistido com ou sem restrição do fluxo sanguíneo no tratamento da dor na osteoartrite de joelho: um ensaio clínico randomizado
Fernando Schorr Grossl; Marzo Edir Da-Sila-Grigoletto; Fátima Ferretti; Sedinei Lopes Copatti; Vanessa da Silva Corralo; Clodoaldo Antônio De-Sá
Abstract
BACKGROUND AND OBJECTIVES: Physical exercise is an efficient non-pharmacological strategy for the treatment of knee osteoarthritis (KOA). Blood flow restriction (BFR) is a technique known to enhance strength and hypertrophy gains when combined with low-intensity resistance exercise. This study aimed to analyze the effects of 12 weeks of low-intensity resistance training with and without blood flow restriction (BFR) on pain control and strength improvement in patients with KOA.
METHODS: Two intervention groups performed low-intensity resistance exercise (knee joint extension on the leg extension chair at 30% of one repetition maximum) with (LI+BFR, n=13) or without blood flow restriction (LI, n=13), twice a week for 12 weeks. Pre- and post-test of one repetition maximum, functional strength (Chair-test), peak torque for unilateral knee extension exercise and pain (Visual Analogue Scale) were evaluated.
RESULTS: No statistically significant differences were observed between treatments in pain reduction (p>0.05). Both interventions increased muscle strength and functional strength after 12 weeks of intervention (p<0.05). The peak torque for knee joint extension increased only in the LI+BFR group (p<0.05). Has no difference in reducing pain in patients with KOA among the groups (p< 0.05), both in the LI+BFR and the LI group.
CONCLUSION: The results of the present study showed that BFR associated with low-intensity resistance exercise does not produce additional effects in terms of pain reduction and strength gain in patients with knee osteoarthritis, when compared to resistance exercise alone.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: O exercício físico é uma estratégia não farmacológica eficiente para o tratamento da osteoartrite de joelho (OAJ). A restrição do fluxo sanguíneo (RFS) é uma técnica conhecida por potencializar o ganho de força e hipertrofia quando combinada com exercícios de resistência de baixa intensidade. Este estudo teve como objetivo analisar os efeitos de 12 semanas de treinamento de resistência de baixa intensidade com e sem restrição de fluxo sanguíneo (RFS) no controle da dor e melhora da força em pacientes com OAJ.
MÉTODOS: Dois grupos de intervenção realizaram exercício resistido de baixa intensidade (extensão da articulação do joelho na cadeira extensora a 30% de uma repetição máxima) com (ER+RFS, n=13) ou sem restrição do fluxo sanguíneo (ER, n=13), duas vezes por semana durante 12 semanas. Foram avaliados pré e pós-teste de uma repetição máxima, força funcional (Chair-test), pico de torque para exercício de extensão de joelho unilateral e dor (Escala Analógica Visual).
RESULTADOS: Não foram observadas diferenças estatisticamente significativas entre os tratamentos na redução da dor (p>0,05). Ambas as intervenções aumentaram a força muscular e a força funcional após 12 semanas de intervenção (p<0,05). O pico de torque para extensão da articulação do joelho aumentou apenas no grupo ER+RFS (p<0,05). A dor crônica relacionada à OAJ não apresentou diferença estatisticamente significativa na redução da dor (p> 0,05) em resposta a ambas as intervenções.
CONCLUSÃO: Os resultados do presente estudo evidenciaram que a RFS associada ao exercício de resistência de baixa intensidade não prouduz efeitos adicinais na redução da dor e no ganho de força em pacientes com osteoartrite de joelho, quando comparada apenas ao exercício de resistência.
Palavras-chave
Referências
1 Incze MA. I have arthritis of the knees: what should i do? JAMA Intern Med. 2019;179(5):736.
2 Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554-7.
3 Mandl LA. Osteoarthritis year in review 2018: clinical. Osteoarthritis Cartilage. 2019;27(3):359-64.
4 Brazilian Society of Rheumatology. Osteoartrite (Artrose). 2011; Available at:
5 Jorge RT, Souza MC, Jones A, Lombardi Júniore I, Jennings F, Natour J. Progressive resistance training in chronic musculoskeletal disorders. Braz J Reumatol. 2009;49(6):726-34.
6 Takagi S, Omori G, Koga H, Endo K, Koga Y, Nawata A, Endo N. Quadriceps muscle weakness is related to increased risk of radiographic knee OA but not its progression in both women and men: the Matsudai Knee Osteoarthritis Survey. Knee Surg Sports Traumatol Ar-throsc. 2018;26(9):2607-14.
7 Harper SA, Roberts LM, Layne AS, Jaeger BC, Gardner AK, Sibille KT, Wu SS, Vincent KR, Fillingim RB, Manini TM, Buford TW. Blood-flow restriction resistance exercise for older adults with knee osteoarthritis: a pilot randomized clinical trial. J Clin Med. 2019;8(2):265.
8 Fusco O, Ferrini A, Santoro M, Lo Monaco MR, Gambassi G, Cesari M. Physical function and perceived quality of life in older persons. Aging Clin Exp Res. 2012;24(1):68-73.
9 Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP; American College of Sports Medicine. American College of Sports Medicine posi-tion stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-59.
10 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;27:477-86.
11 Ferraz RB, Gualano B, Rodrigues R, Kurimori CO, Fuller R, Lima FR, DE Sá-Pinto AL, Ros-chel H. Benefits of resistance training with blood flow restriction in knee osteoarthritis. Med Sci Sports Exerc. 2018;50(5):897-905.
12 Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18.
13 Aguiar GC, Do Nascimento MR, De Miranda AS, Rocha NP, Teixeira AL, Scalzo PL. Effects of an exercise therapy protocol on inflammatory markers, perception of pain, and physical per-formance in individuals with knee osteoarthritis. Rheumatol Int. 2015;35(3):525-31.
14 Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-74.
15 Martinez JE, Grassi DC, Marques LG. Analysis of the applicability of different pain question-naires in three hospital settings: outpatient clinic, ward and emergency unit. Rev Bras Reuma-tol. 2011;51(4):299-308.
16 Martins W, Oliveira R, Silva M, et al. Assessment of knee extension strength in older adults: re-liability of an isokinetic testing protocol. Rev Bras Ativ Física Saúde. 2015;20(4):435-435.
17 Siqueira CM, Pelegrini FRMM, Fontana MF, Greve JMD. Isokinetic dynamometry of knee flexors and extensors: comparative study among non-athletes, jumper athletes and runner athle-tes. Rev Hosp Clin Fac Med São Paulo. 2002;57(1):19-24.
18 Rikli RE, Jones C J. Senior fitness test manual. Champaign, IL: Human kinetics Publishers; 2013.
19 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Taylor and Francis; 2013. Available at:
20 Sawilowsky SS. New effect size rules of thumb. J Mod Appl Stat Methods. 2009;8(2):26.
21 Berben L, Sereika SM, Engberg S. Effect size estimation: methods and examples. Int J Nurs Stud. 2012;49(8):1039-47.
22 Loenneke J, Fahs CA, Rossow LM, Abe T, Bemben MG. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Med Hypotheses. 2012;78(1):151-4.
23 Messier SP, Mihalko SL, Beavers DP. 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. 2021;325(7):646-57.
24 Lorenz DS, Bailey L, Wilk KE, Mangine RE, Head P, Grindstaff TL, Morrison S. Blood flow restriction training. J Athl Train. 2021;56(9):937-44.
25 Lixandrão ME, Ugrinowitsch C, Laurentino G. Effects of exercise intensity and occlusion pres-sure after 12 weeks of resistance training with blood-flow restriction. Eur J Appl Physiol. 2015;115(12):2471-80.
26 Bryk FF, Dos Reis AC, Fingerhut D. Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1580-6.
27 Trombetti A, Reid KF, Hars M, Herrmann FR, Pasha E, Phillips EM, Fielding RA. Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life. Osteoporos Int. 2016;27(2):463-71.
28 Lixandrao ME, Ugrinowitsch C, Berton R. Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis. Sports Med. 2018;48(2):361-78.
29 Hughes L, Patterson SD. The effect of blood flow restriction exercise on exercise-induced hypo-algesia and endogenous opioid and endocannabinoid mechanisms of pain modulation. J App Physiol. 2020;128(4):914-24.
30 Creamer P, Lethbridge-Cejku M, Hochberg MC. Factors associated with functional impair-ment in symptomatic knee osteoarthritis. Rheumatology. 2000;39(5):490-6.
31 Rocha TC, Ramos PDS, Dias AG, Martins EA. The effects of physical exercise on pain mana-gement in patients with knee osteoarthritis: a systematic review with metanalysis. Rev Bras Or-top. 2020;55(5):509-17.
32 Dor A, Kalichman L. A myofascial component of pain in knee osteoarthritis. J Bodyw Mov Ther. 2017;21(3):642-7.
33 Bushnell MC, Čeko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013;14(7):502-11.
34 Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Araya-Quintanilla F, Gutiérrez-Espinoza H. The addition of blood flow restriction to resistance exercise in individuals with knee pain: a systematic review and meta-analysis. Braz J Phys Ther. 2020;24(6):465-78.
35 Behringer M, Heinke L, Leyendecker J, Mester J. Effects of blood flow restriction during mo-derate-intensity eccentric knee extensions. J Physiol Sci. 2018;68(5):589-99.
36 Shiromaru FF, De Salles Painelli V, Silva-Batista C. Differential muscle hypertrophy and edema responses between high-load and low-load exercise with blood flow restriction. Scand J Med Sci Sports. 2019;29(11):1713-26.
Submetido em:
25/01/2023
Aceito em:
27/03/2023