High-intensity strength training may not improve pain in knee osteoarthritis: JAMA

Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. However, little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Therefore, Dr Stephen P. Messier and team conducted a study determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis.

The START trial was a double-blind, randomized study conducted at a university research centre in North Carolina that included 377 community-dwelling adults (≥50 years) with body mass index (BMI) ranging from 20 to 45 and with knee pain and radiographic knee osteoarthritis. Researchers randomized patients to receive high-intensity strength training (n = 127), low-intensity strength training (n = 126), or attention control (n = 124). The major outcomes assessed at the 18-month follow-up were Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking.

Key findings of the study were:

• At the 18-month follow-up assessment, researchers found that WOMAC pain scores did not differ between the high-intensity and the low-intensity groups (5.1 vs 4.4) or between the high-intensity and control groups (5.1 vs 4.9).

• They also found no statistically significant differences in mean knee joint compressive forces between the high-intensity and low-intensity groups (2,453 vs 2,475 N), or between the high-intensity and control groups (2,453 vs 2,512 NP).

• Among 87 nonserious adverse events occurred, 53 were in the high-intensity group, compared with 30 in the low-intensity group and 4 in the control group.

The authors concluded, "Among patients with knee osteoarthritis, high-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months. The findings do not support the use of high-intensity strength training over low-intensity strength training or an attention control in adults with knee osteoarthritis."

For further information:

https://jamanetwork.com/journals/jama/article-abstract/2776330