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Published on: July 5, 2017
High-Intensity Resistance Training Enhances Strength, But Not Muscle Mass and Physical Functioning Gains during Total
Alejandra P Monsegue1, Esther J C Wilms1, Charlotte S Kramer2
1Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Purpose:
To determine whether high-intensity resistance exercise training with nutritional support (RET) during recovery from total knee arthroplasty induces greater improvements in muscle-related outcomes compared with standard rehabilitation (SR) alone.
Methods:
Thirty-three patients (70 ± 6 yr; 28.7 ± 3.1 kg⋅m -2 ) were randomized to receive RET (intervention + regular rehabilitation, n = 18) or SR (regular rehabilitation only, n = 15) for 12 wk, starting 8 wk post-TKA. RET involved supervised, bilateral, high-intensity resistance exercise, 3×/wk, daily supplementation (45 g protein, 5.5 g Vivinal GOS, 800 IU vitamin D, 366 mg calcium), and dietary counseling. Outcomes included bilateral and unilateral leg press one-repetition maximum, DXA-derived appendicular lean mass, computed tomography-derived quadriceps cross-sectional area, 6-min walking test, and 5-times chair-stand test (5CST). Data are mean ± SD, analyzed with two-way repeated-measures ANOVAs, or median [IQR], analyzed with Wilcoxon Signed-Rank test.
Results:
Bilateral leg press one-repetition maximum improved to a greater extent following RET (131 ± 38 to 174 ± 56 kg; P < 0.001) versus SR (124 ± 36 to 143 ± 49 kg, P = 0.018, P value of interaction [ Pint ] = 0.026). Strength in the nonoperated leg increased in the RET group only (RET: 22% ± 17%, P < 0.001, SR: 6% ± 11%, P = 0.175, Pint = 0.002). Operated leg strength increased similarly between groups (RET: 51% ± 33%, SR: 40% ± 30%, P value of main time effect [ Ptime ] < 0.001, Pint = 0.338), as did appendicular lean mass (RET: 0.5 ± 0.8 kg, SR: 0.3 ± 0.8 kg, Ptime = 0.009, Pint = 0.390), and quadriceps cross-sectional area (operated: RET: 7.8% ± 7.5%, SR: 9.2% ± 5.9%, nonoperated: RET: 4.8% ± 4.5%, SR: 3.8% ± 3.7%, Ptime < 0.001, Pint ≥ 0.557). Six-minute walking test improved more in the SR (428 ± 94 to 513 ± 75 m, P < 0.001) versus RET group (417 ± 69 to 460 ± 72 m, P = 0.002, Pint = 0.034). 5CST only improved significantly following RET (RET: 15.3 [4.2] to 13.2 [3.9] s, P = 0.039, SR: 14.4 [4.0] to 14.4 [5.1] s, P = 0.064).
Conclusions:
Compared with standard total knee arthroplasty rehabilitation, high-intensity resistance training with nutritional support induces greater gains in bilateral strength but not muscle mass or physical functioning.
