Eccentric and Concentric Resistance Exercise Comparison for Knee Osteoarthritis

Abstract

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 (R 2 = 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.

Effects of exercise on knee osteoarthritis: A systematic review

“…Additionally, when comparing both intervention groups with each other, the rate of weekly strength gain was greater for the concentric exercise group than for the eccentric exercise group, for leg press and knee flexion, but not for knee extension. However, at the end of the study, the difference between those two groups was not statistically significant (Vincent et al, 2019).…”

“…Concerning strength evaluation, the study including 1RM showed improvement for all leg strength measures, comparing to the control group (Vincent et al, 2019). Additionally, when comparing both intervention groups with each other, the rate of weekly strength gain was greater for the concentric exercise group than for the eccentric exercise group, for leg press and knee flexion, but not for knee extension.…”

“…Barely one study gives information about procedures for blinding of outcome patients (Lai, Zhang, Lee, & Wang, 2018) being considered as having a low risk for bias, while seven studies report that patients were not blinded to the procedures, being considered high risk for bias (Henriksen et al, 2014;Mazloum et al, 2018;Munukka et al, 2016;Shellington et al, 2019;Silva et al, 2015;Simão et al, 2012;Vincent, Vasilopoulos, Montero, & Vincent, 2019). The remaining studies fail to give information about it, leaving the possibility of bias unclear.…”

“…On the other hand, the majority of studies report blinding of the outcome assessors, with only two studies being considered high risk of bias (Shellington et al, 2019;Vincent et al, 2019) and the remaining ones unclear risk of bias (Braghin, Libardi, Junqueira, NogueiraBarbosa, & de Abreu, 2018;DeVita et al, 2018;Ha et al, 2018;Huang et al, 2020;Karadağ et al, 2019;Liu et al, 2019).…”

“…The 19 RCTs involved in our systematic review assessed a wide range For pain assessment, different instruments were used, such as Knee Injury and Osteoarthritis Outcome Score (KOOS) (Henriksen et al, 2014;Liu et al, 2019;Munukka et al, 2016;Wang et al, 2011), Visual Analogue Scale for Pain (VAS-P) (Karadağ et al, 2019), Western Ontario and McMaster Universities Arthritis Index (WOMAC) (Braghin et al, 2018;de Oliveira et al, 2012;DeVita et al, 2018;Dias et al, 2017;Ha et al, 2018;Karadağ et al, 2019;Shellington et al, 2019;Simão et al, 2012;Vincent et al, 2019), Lequesne Algofunctional Index (de Oliveira et al, 2012;Mazloum et al, 2018;Silva et al, 2015) and Numerical Rating Scale (Imoto et al, 2012).…”