Clinical trial NCT01713140: Experimental Study of Strength Training to Activate the Quadriceps Muscle After Total Knee Arthroplasty
Official title: Central (CNS) Activation of the Quadriceps Muscle During Strength Training With Repetitions to Contraction Failure After Total Knee Arthroplasty
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Osteoarthritis, Knee
Keywords: strength training
resistance training
fatigue
knee extension
total knee arthroplasty
total knee replacement
electromyography
physical therapy modalities
Lead sponsor: Copenhagen University Hospital, Hvidovre
Sponsor class: OTHER
Collaborators: name: University of Southern Denmark
First posted: 2012-10-24
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: BASIC_SCIENCE

Brief summary: 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.


Eligibility criteria: 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

Primary outcomes:
measure: Change from 10% contraction failure in normalized EMG amplitude (%EMGmax).
timeFrame: 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.
measure: Change from 10% contraction failure in median power frequency (Hz)
timeFrame: 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.
Secondary outcomes:
measure: Change from baseline (pre strength training) in Nm/kg body mass
timeFrame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.
measure: Change from baseline (pre strength training) in knee pain (VAS-mm)
timeFrame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.
Other outcomes:
measure: Change from baseline (pre strength training) in perceived exertion (Borg CR 10 scale points)
timeFrame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.
Locations:
city: Copenhagen
country: Denmark
facility: Clinical Reaserch Center, Copenhagen University Hospital, Hvidovre
state: Hvidovre
Study officials:
affiliation: Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
name: Thomas Bandholm, PhD
role: STUDY_DIRECTOR
References:
citation: Thomas AC, Stevens-Lapsley JE. Importance of attenuating quadriceps activation deficits after total knee arthroplasty. Exerc Sport Sci Rev. 2012 Apr;40(2):95-101. doi: 10.1097/JES.0b013e31824a732b.
citation: Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible? Disabil Rehabil. 2012;34(12):1034-40. doi: 10.3109/09638288.2011.629019. Epub 2011 Nov 15.
citation: Sundstrup E, Jakobsen MD, Andersen CH, Zebis MK, Mortensen OS, Andersen LL. Muscle activation strategies during strength training with heavy loading vs. repetitions to failure. J Strength Cond Res. 2012 Jul;26(7):1897-903. doi: 10.1519/JSC.0b013e318239c38e.
citation: Mikkelsen EK, Jakobsen TL, Holsgaard-Larsen A, Andersen LL, Bandholm T. Strength Training to Contraction Failure Increases Voluntary Activation of the Quadriceps Muscle Shortly After Total Knee Arthroplasty: A Cross-sectional Study. Am J Phys Med Rehabil. 2016 Mar;95(3):194-203. doi: 10.1097/PHM.0000000000000361.