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Concentric versus combined concentric-eccentric isokinetic training: Effects on functional capacity and symptoms in patients with osteoarthrosis of the knee,☆☆,,★★,

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Abstract

Gür H, Çakfın N, Akova B, Okay E, Küçükoğlu S. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Arch Phys Med Rehabil 2002;83:308-16. Objective: To compare the effects of concentric and coupled concentric-eccentric isokinetic resistance training on functional capacity and symptoms of patients with osteoarthrosis (OA) of both knees. Design: Repeated measures. Setting: A university exercise physiology laboratory. Participants: Twenty-three volunteers, ages 41 to 75 years. Patients were randomly assigned to 3 groups: concentric (CON, n = 9), concentric-eccentric (CON-ECC, n = 8), and nontreatment (NONTX, n = 6). Interventions: The CON group performed 12 concentric contractions of each knee extensor and flexor muscles; the CON-ECC group performed 6 concentric and 6 eccentric contractions of each knee muscle group by using a spectrum of angular velocities ranging from 30°/s to 180°/s with 30°/s intervals, for both sides, 3 days a week for 8 weeks. Main Outcome Measures: Functional capacity (rising from a chair, walking, stair climbing and descending) and pain during rest and activities, peak torque, and cross-sectional area (CSA) of knee muscle groups of subjects were tested before and after training. Results: Both training groups showed marked decreases (P <.001) in pain scores and increases (P <.001) in functional capacity together with increases (P <.05–.01) in peak torque and CSA of knee muscles. However, the NONTX group did not display these marked changes after the 8-week period. The results also indicated that concentric-eccentric training has a greater influence on functional capacity, especially stair climbing and descending, than that of concentric training when compared with NONTX group; however, the improvements in pain measurements were better in the CON group compared with the CON-ECC group after the training. Conclusions: The results suggest that with the isokinetic resistance training used in this study, it is possible to improve functional capacity and decrease pain in patients with OA of the knee. The results also showed that extensive training involving a high number of repetitions and eccentric contractions was safe, effective, and well tolerated for the patients with knee OA. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Patients

Volunteers were qualified, and 23 patients with bilateral complaints of knee OA, who had grade 2 or 3 OA, as judged by criteria of Kellgren and Lawrence,18 based on weight-bearing radiographs, were admitted in this study. All volunteers went through a medical examination (cardiovascular, respiratory) before the study, and those who did not have any health problems that might pose a risk during the maximal test and training were included in the study. The patients had not undergone any

Patients

The selected characteristics and grade of OA in the patients were not significantly different between the groups (table 1).

Table 1: Selected physical characteristics of the 3 test groups

Empty CellECC-CON (n = 8)CON (n = 9)NONTX (n = 6)
Age (y)55 ± 1256 ± 1257 ± 9
Height (cm)159 ± 11156 ± 11157 ± 7
Body weight (kg)79.9 ± 5.578.2 ± 10.079.5 ± 11.8
OA on x-ray*
 Right knee2.4 ± 1.02.3 ± 1.02.3 ± 1.0
 Left knee2.5 ± 1.02.4 ± 0.42.6 ± 1.0
*Rated on the Kellgren scale.

NOTE. No significant differences between groups by

Discussion

In summary, both training groups showed marked decreases in pain scores and increases in functional capacity, as well as a significant increase in peak torque and CSA of knee muscles. Because NONTX group patients were tested twice during the 8-week period and did not display these marked changes, it is difficult to attribute the improvements in training groups to the learning curve for the tests' procedures. The improvements in functional measurements were better in the CON-ECC group,

Conclusion

Our results showed that with the training programs used in this study, it is possible to improve functional capacity and to decrease pain in the patients with knee OA 2 to 3 times better than those reported in the similar studies. However, the small number of subjects involved in the groups of our study limits the authors in making a generalization. The results indicated that concentric-eccentric–coupled isokinetic training has a slightly better influence on the functional capacity of the

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    ☆☆

    Reprint requests to Hakan Gür, MD, PhD, Dept of Sports Medicine, Medical School of Uludağ University, 16059 Bursa, Turkey, e-mail: [email protected].

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