Experimental Study of Strength Training to Activate the Quadriceps Muscle After Total Knee Arthroplasty

NCT01713140 | Completed DMC

• 1 other identifier: EA2012_2013
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Progressive strength training is a training modality used in rehabilitation after total knee arthroplasty (TKA). Strength deficits up to 80% in the quadriceps muscle is shown to be present in the operated leg after TKA, which relates to reduced central nervous system (CNS) activation of the muscle. As increased CNS activation occurs during strength training when muscular fatigue is approaching in healthy subjects, it is relevant to investigate if this also is the case after TKA. The clinical implication is that repetitions performed to contraction failure during strength training, may help reduce CNS activation deficits of the quadriceps muscle after TKA. Purpose: The aim of this study is to investigate CNS activation of the quadriceps muscle during strength training performed with repetitions to contraction failure after TKA. Method: Electromyographic (EMG) activity of the vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST) and biceps femoris (BF) muscles will be recorded during knee extensions performed in a knee extension machine until contraction failure. The relative loading will be 10 repetition maximum (RM). The absolute load (kilograms) corresponding to 10 RM is defined a minimum of 3 days before the day where the EMG-data are recorded. The primary outcomes will be normalized EMG amplitude and median power frequency for each 10th (10%, 20%, 30% failure, etc.) of the set to failure. Hypothesis: Based on previous findings in healthy subjects, we hypothesize that in patients with a TKA, the EMG amplitude will increase while the median power frequency will decrease during a strength training set performed to contraction failure after TKA.

Conditions

Osteoarthritis, Knee

Keywords

strength training; resistance training; fatigue; knee extension; total knee arthroplasty; total knee replacement; electromyography; physical therapy modalities

Outcome Measures

Primary Outcomes (2)

• Change from 10% contraction failure in normalized EMG amplitude (%EMGmax).

  EMG amplitude-data from the set performed until contraction failure will be reduced to time points corresponding to 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100% contraction failure.

  10% to 100% contraction failure in a single set performed until contraction failure. The set is performed at a single day, 4 to 8 weeks after surgery.

• Change from 10% contraction failure in median power frequency (Hz)

  Median power frequency-data from the set performed until contraction failure will be reduced to time points corresponding to 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100% contraction failure.

  10% to 100% contraction failure in a single set performed until contraction failure. The set is performed at a single day, 4 to 8 weeks after surgery.

Secondary Outcomes (2)

• Change from baseline (pre strength training) in Nm/kg body mass

  From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.

• Change from baseline (pre strength training) in knee pain (VAS-mm)

  From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.

Other Outcomes (1)

• Change from baseline (pre strength training) in perceived exertion (Borg CR 10 scale points)

  From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.

Study Arms (1)

1 strength training set performed until contraction failure

EXPERIMENTAL

Knee extensions until contraction failure will be performed, using a relative loading of 10 repetition maximum (RM).

Other: 1 strength training set performed until contraction failure

Interventions

1 strength training set performed until contraction failure OTHER

Electromyographic (EMG) activity of the vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST) and biceps femoris (BF) muscles will be recorded during knee extensions performed in a knee extension machine in a single set performed until contraction failure. The relative loading will be 10 repetition maximum (RM). The absolute load (kilograms) corresponding to 10 RM is defined a minimum of 3 days before the day where the EMG-data are recorded. Range of motion and time under tension for each repetition will be controlled for.

Also known as: Resistance training.

1 strength training set performed until contraction failure

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Unilateral primary TKA
• Between the age of 18 to 80 years
• Understand and speak Danish
• Informed consent
• to 8 weeks after TKA

You may not qualify if:

• Disease/Musculoskeletal disorder, which requires special rehabilitation modality
• Alcohol and drug abuse
• Lack of wish to participate or unwillingness to sign an informed consent

Sponsors & Collaborators

• Copenhagen University Hospital, Hvidovre: lead
• University of Southern Denmark: collaborator

Study Sites (1)

Clinical Reaserch Center, Copenhagen University Hospital, Hvidovre

Copenhagen, Hvidovre, 2650, Denmark

Location

Related Publications (4)

• Thomas AC, Stevens-Lapsley JE. Importance of attenuating quadriceps activation deficits after total knee arthroplasty. Exerc Sport Sci Rev. 2012 Apr;40(2):95-101. doi: 10.1097/JES.0b013e31824a732b.

  PMID: 22249398 BACKGROUND

• Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible? Disabil Rehabil. 2012;34(12):1034-40. doi: 10.3109/09638288.2011.629019. Epub 2011 Nov 15.

  PMID: 22084974 RESULT

• Sundstrup E, Jakobsen MD, Andersen CH, Zebis MK, Mortensen OS, Andersen LL. Muscle activation strategies during strength training with heavy loading vs. repetitions to failure. J Strength Cond Res. 2012 Jul;26(7):1897-903. doi: 10.1519/JSC.0b013e318239c38e.

  PMID: 21986694 RESULT

• Mikkelsen EK, Jakobsen TL, Holsgaard-Larsen A, Andersen LL, Bandholm T. Strength Training to Contraction Failure Increases Voluntary Activation of the Quadriceps Muscle Shortly After Total Knee Arthroplasty: A Cross-sectional Study. Am J Phys Med Rehabil. 2016 Mar;95(3):194-203. doi: 10.1097/PHM.0000000000000361.

  PMID: 26339729 DERIVED

MeSH Terms

Conditions

Osteoarthritis, Knee; Fatigue

Interventions

Resistance Training

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Physical Conditioning, Human; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Thomas Bandholm, PhD

  Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Physiotherapist

Study Record Dates

• First Submitted: October 18, 2012
• First Posted: October 24, 2012
• Study Start: October 1, 2012
• Primary Completion: March 1, 2013
• Study Completion: March 1, 2013
• Last Updated: June 25, 2013

Record last verified: 2013-06

Locations

DK (1)