Experimental Study of Strength Training to Activate the Quadriceps Muscle After Total Knee Arthroplasty
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Purpose
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.
| Condition | Intervention |
|---|---|
|
Osteoarthritis, Knee |
Other: 1 strength training set performed until contraction failure |
| Study Type: | Interventional |
| Study Design: | Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Basic Science |
| Official Title: | Central (CNS) Activation of the Quadriceps Muscle During Strength Training With Repetitions to Contraction Failure After Total Knee Arthroplasty |
- Change from 10% contraction failure in normalized EMG amplitude (%EMGmax). [ Time Frame: 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. ] [ Designated as safety issue: No ]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.
- Change from 10% contraction failure in median power frequency (Hz) [ Time Frame: 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. ] [ Designated as safety issue: No ]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.
- Change from baseline (pre strength training) in Nm/kg body mass [ Time Frame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery. ] [ Designated as safety issue: No ]Maximal isometric knee-extension force will be measured, using a fixated hand-held dynamometer, and expressed as the maximal voluntary torque per kilo body mass, using the external lever arm and body weight of each subject.
- Change from baseline (pre strength training) in knee pain (VAS-mm) [ Time Frame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery. ] [ Designated as safety issue: No ]Knee pain is scored by each subject at rest and during strength training, using a standard VAS-ruler with endpoints of "no pain" (0 mm) and "worst pain imaginable" (100 mm).
- Change from baseline (pre strength training) in perceived exertion (Borg CR 10 scale points) [ Time Frame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery. ] [ Designated as safety issue: No ]The rate of perceived exertion scale (Borg CR 10) is used to monitor the subjects self-reported experience of exertion.
| Estimated Enrollment: | 20 |
| Study Start Date: | October 2012 |
| Estimated Study Completion Date: | June 2013 |
| Primary Completion Date: | March 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: 1 strength training set performed until contraction failure
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
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.
Other Name: Resistance training.
|
Eligibility| Ages Eligible for Study: | 18 Years to 80 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Unilateral primary TKA
- Between the age of 18 to 80 years
- Understand and speak Danish
- Informed consent
- 4 to 8 weeks after TKA
Exclusion Criteria:
- Disease/Musculoskeletal disorder, which requires special rehabilitation modality
- Alcohol and drug abuse
- Lack of wish to participate or unwillingness to sign an informed consent
Contacts and Locations| Denmark | |
| Clinical Reaserch Center, Copenhagen University Hospital, Hvidovre | |
| Copenhagen, Hvidovre, Denmark, 2650 | |
| Study Director: | Thomas Bandholm, PhD | Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark |
More Information
Publications:
| Responsible Party: | Elin Andersson, Physiotherapist, Copenhagen University Hospital, Hvidovre |
| ClinicalTrials.gov Identifier: | NCT01713140 History of Changes |
| Other Study ID Numbers: | EA2012_2013 |
| Study First Received: | October 18, 2012 |
| Last Updated: | April 3, 2013 |
| Health Authority: | Denmark: The Danish National Committee on Biomedical Research Ethics Denmark: Danish Dataprotection Agency |
Keywords provided by Copenhagen University Hospital, Hvidovre:
|
strength training resistance training fatigue knee extension |
total knee arthroplasty total knee replacement electromyography physical therapy modalities |
Additional relevant MeSH terms:
|
Osteoarthritis Osteoarthritis, Knee Arthritis |
Joint Diseases Musculoskeletal Diseases Rheumatic Diseases |
ClinicalTrials.gov processed this record on May 22, 2013