The Role of Resistance Training in the Management of Knee Osteoarthritis

Kim L Bennell, Rana S Hinman
European Musculoskeletal Review, 2011;6(1):10-13
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Abstract

Abstract
Exercise is a core component of the management of knee osteoarthritis (OA). Given the fact that muscle weakness is associated with knee OA and has a significant impact on pain and function, muscle strengthening is a key feature of most exercise regimes for knee OA. Systematic reviews confirm the benefits of resistance training for improving pain and function in knee OA. The type and dosage of resistance training does not seem to influence outcomes, although more than 12 direct supervision sessions may improve effect sizes. Further research is needed to evaluate the effects of muscle strengthening on other outcomes such as quality of life and psychological parameters. The long-term benefits of resistance exercise are limited by lack of adherence to exercise, and strategies to maximise participation over time are necessary. Recent attention has also focused on whether muscle strengthening can slow disease progression. However, the few clinical trials that have investigated this have not shown effects of resistance training on structural outcomes.

Keywords
Muscle, osteoarthritis, knee, strengthening, exercise

Disclosure: The authors have no conflicts of interest to declare.
Received: 1 August 2010 Accepted: 7 January 2011 Citation: European Musculoskeletal Review, 2011;6(1):10–3

Correspondence: Kim L Bennell, Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, VIC 3010, Australia. E: k.bennell@unimelb.edu.au

Knee osteoarthritis (OA), primarily affecting the medial tibiofemoral joint compartment, is a chronic joint disorder that imposes a significant healthcare burden. As there is no cure, traditional management aims to reduce pain, improve function and enhance quality of life while minimising adverse effects of therapy. Non-pharmacological conservative interventions are considered the first-line approach to symptom management, and exercise isrecommended by all clinical guidelines.1,2 Exercise therapy for people with knee OA may take many forms; however, given the fact that muscle weakness is associated with knee OA and has a significant impact on pain and function,3 muscle strengthening is a key component of most exercise regimes for knee OA. Recent attention has also focused on whether muscle strengthening can slow disease progression in addition to improving symptoms. This article will describe the deficits in muscle strength observed in people with knee OA and evaluate the effects of resistance training programmes on strength, OA symptoms and disease progression.

Deficits in Muscle Strength in Knee Osteoarthritis
Muscle weakness, particularly of the quadriceps, has long been recognised as a hallmark of the disease. However, only a small number of studies in the OA literature have correctly measured strength as torque (Nm) and normalised for body mass (kg) differences. These studies suggest that patients with knee OA of varying severity are in the order of 20–40% weaker in terms of knee extensor strength relative to body mass than healthy controls.4–9 Lower strength in those with only early OA is less clear, with one study failing to find any difference in strength between those with early disease and controls without knee OA10 and another finding that those with early OA were 18% weaker.9 In addition to weakness of the quadriceps muscle, people with knee OA exhibit significant strength deficits of the hip muscles. In a recent study, compared with controls, strength deficits in a group of 89 people with knee OA ranged from 16% (hip extensors) to 27% (hipexternal rotators).11 Disease severity was not related to the extent of hip muscle weakness, except for in the hip abductors, where more severe disease was associated with greater weakness. These findings support the inclusion of hip-strengthening exercises in rehabilitation programmes for knee OA.

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