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Precision Medicine Approach to Develop and Internally Validate Optimal Exercise and Weight-Loss Treatments for Overweight and Obese Adults With Knee Osteoarthritis: Data From a Single-Center Randomized Trial.
Jiang, X, Nelson, AE, Cleveland, RJ, Beavers, DP, Schwartz, TA, Arbeeva, L, Alvarez, C, Callahan, LF, Messier, S, Loeser, R, et al
Arthritis care & research. 2021;(5):693-701
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Abstract
OBJECTIVE To apply a precision medicine approach to determine the optimal treatment regime for participants in an exercise (E), dietary weight loss (D), and D + E trial for knee osteoarthritis that would maximize their expected outcomes. METHODS Using data from 343 participants of the Intensive Diet and Exercise for Arthritis (IDEA) trial, we applied 24 machine-learning models to develop individualized treatment rules on 7 outcomes: Short Form 36 physical component score, weight loss, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain/function/stiffness scores, compressive force, and interleukin-6 level. The optimal model was selected based on jackknife value function estimates that indicate improvement in the outcomes if future participants follow the estimated decision rule compared to the optimal single, fixed treatment model. RESULTS Multiple outcome random forest was the optimal model for the WOMAC outcomes. For the other outcomes, list-based models were optimal. For example, the estimated optimal decision rule for weight loss indicated assigning the D + E intervention to participants with baseline weight not exceeding 109.35 kg and waist circumference above 90.25 cm, and assigning D to all other participants except those with a history of a heart attack. If applied to future participants, the optimal rule for weight loss is estimated to increase average weight loss to 11.2 kg at 18 months, contrasted with 9.8 kg if all participants received D + E (P = 0.01). CONCLUSION The precision medicine models supported the overall findings from IDEA that the D + E intervention was optimal for most participants, but there was evidence that a subgroup of participants would likely benefit more from diet alone for 2 outcomes.
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Compression of Myofascial Trigger Points With a Foam Roller or Ball for Exercise-induced Anterior Knee Pain: A Randomized Controlled Trial.
Li, L, Huang, F, Huang, Q, Liu, L, Opoku Antwi, E, Nguyen, T
Alternative therapies in health and medicine. 2020;(3):16-23
Abstract
OBJECTIVE The study aimed to evaluate the effectiveness of compression of myofascial trigger points (MTrPs) with a foam roller or ball, combined with static stretching of knee muscles, on exercise-induced, anterior knee pain in fitness runners. DESIGN The research team designed a randomized controlled trial. SETTING The study took place in the Department of Sports Medicine and Rehabilitation Center of the School of Kinesiology at Shanghai University of Sport in Shanghai, China. PARTICIPANTS A total of 80 participants, 28 males and 52 females with an average age of 37.2 ± 2.9 years, were recruited at the center. INTERVENTION The participants were randomly assigned to one of 4 groups, with 20 participants in each group: (1) the MG+SG group, which received compression with a foam roller or ball (MG) and static stretching (SG); (2) the MG group, which received compression only; (3) the SG group static, which received static stretching only; or (4) the control group (CG), which attended a 30-min class about nutrition or exercise once a month and received no intervention. For the MG intervention, participants' MTrPs were compressed with a foam roller or ball for 30 minutes once every 5 days for 2 months. After each compression, the MG+SG group received static stretching immediately. OUTCOME MEASURES A visual analog scale (VAS) and a participant's range of motion (ROM) of the knee were assessed at baseline, after 4 weeks of the intervention, immediately postintervention, and at a follow-up at 8 weeks postintervention. The effectiveness of the treatment in the different groups was also compared. RESULTS Immediately postintervention, 18 participants (90%) in MG+SG group, 12 (60%) in MG group, and 8 (40%) in the SG group were pain free. Compared with those at baseline, the VAS scores of the MG+SG group significantly improved between baseline and postintervention and were unchanged at the eight-week follow-up. In all groups, the VAS scores and ROMs of the knee increased, but only the MG+SG group's values increased significantly. CONCLUSIONS Compression of MTrPs with a foam roller or ball, combined with static stretching, was more effective than either the compression only or static stretching only.
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Effect of milk fat globule membrane supplementation on motor unit adaptation following resistance training in older adults.
Watanabe, K, Holobar, A, Tomita, A, Mita, Y
Physiological reports. 2020;(12):e14491
Abstract
This study aimed to investigate the effect of milk fat globule membrane (MFGM) supplementation on motor unit adaptation following resistance training in older adults. Twenty-five older males and females took MFGM (n = 12) or a placebo (PLA; n = 12) while performing 8 weeks of isometric knee extension training. During the training, the motor unit firing pattern during submaximal contractions, muscle thickness, and maximal muscle strength of knee extensor muscles were measured every 2 weeks. None of the measurements showed significant differences in muscle thickness or maximal muscle strength (MVC) between the two groups (p > .05). Significant decreases in motor unit firing rate following the intervention were observed in PLA, that is, 14.1 ± 2.7 pps at 0 weeks to 13.0 ± 2.4 pps at 4 weeks (p = .003), but not in MFGM (14.4 ± 2.5 pps to 13.8 ± 1.9 pps). Motor unit firing rates in MFGM were significantly higher than those in PLA at 2, 4, 6, and 8 weeks of the intervention, that is, 15.1 ± 2.3 pps in MFGM and 14.5 ± 3.3 pps in PLA at 70% of MVC for motor units recruited at 40% of MVC at 6 weeks (p = .034). Significant differences in firing rates among motor units with different recruitment thresholds were newly observed following the resistance training intervention in MFGM, indicating that motor unit firing pattern is changed in this group. These results suggest that motor unit adaptation following resistance training is modulated by MFGM supplementation in older adults.
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Moderate volume of sprint bouts does not induce muscle damage in well-trained athletes.
Grazioli, R, Lopez, P, Machado, CLF, Farinha, JB, Fagundes, AO, Voser, R, Reischak-Oliveira, Á, Setuain, I, Izquierdo, M, Pinto, RS, et al
Journal of bodywork and movement therapies. 2020;(1):206-211
Abstract
INTRODUCTION Understanding the recovery in response to different sprint protocols is important for optimizing neuromuscular gains and organizing training sessions in sports. The current study aimed to investigate acute neuromuscular changes following a moderate volume of sprint protocols with and without change-of-direction. METHODS 26 well-trained male collegiate athletes from different sports were randomly allocated into straight-line group (SLG) or change-of-direction group (CODG). The protocols were 1 × 15 repetitions of 20-meter sprints in line (SLG) or with two changes in each repetition (CODG). Knee extension maximal and explosive strength, jump performance, serum creatine kinase, and quadriceps and hamstrings echo intensity were collected pre-, post- 0, 24, 48, and 72 h post-exercise. RESULTS There were no significant changes in any of the variables at any time point after the exercise protocols in comparison with pre-exercise values (p > 0.05). CONCLUSIONS The present study suggests that sprint training with moderate volume with or without change of direction does not induce neuromuscular or physiological changes during 72 h post-exercise. This information is especially important for sports staff in order to optimize training prescription and frequency.
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Effectiveness of collagen supplementation on pain scores in healthy individuals with self-reported knee pain: a randomized controlled trial.
Bongers, CCWG, Ten Haaf, DSM, Catoire, M, Kersten, B, Wouters, JA, Eijsvogels, TMH, Hopman, MTE
Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2020;(7):793-800
Abstract
The purpose of this study was to examine the effects of 12 weeks collagen peptide (CP) supplementation on knee pain and function in individuals with self-reported knee pain. Healthy physically active individuals (n = 167; aged 63 [interquartile range = 56-68] years) with self-reported knee pain received 10 g/day of CP or placebo for 12 weeks. Knee pain and function were measured with the Visual Analog Scale (VAS), the Lysholm questionnaire, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Furthermore, we assessed changes in inflammatory, cartilage, and bone (bio)markers. Measurements were conducted at baseline and after 12 weeks of supplementation. Baseline VAS did not differ between CP and placebo (4.7 [2.5-6.1] vs. 4.7 [2.8-6.2], p = 0.50), whereas a similar decrease in VAS was observed after supplementation (-1.6 ± 2.4 vs. -1.9 ± 2.6, p = 0.42). The KOOS and Lysholm scores increased after supplementation in both groups (p values < 0.001), whereas the increase in the KOOS and Lysholm scores did not differ between groups (p = 0.28 and p = 0.76, respectively). Furthermore, CP did not impact inflammatory, cartilage, and bone (bio)markers (p values > 0.05). A reduced knee pain and improved knee function were observed following supplementation, but changes were similar between groups. This suggests that CP supplementation over a 12-week period does not reduce knee pain in healthy, active, middle-aged to elderly individuals. Novelty CP supplementation over a 12-week period does not reduce knee pain in healthy, active, middle-aged to elderly individuals. CP supplementation over a 12-week period does not impact on inflammatory, cartilage, and bone (bio)markers in healthy, active, middle-aged to elderly individuals.
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Novel Approach to Estimate Osteoarthritis Progression: Use of the Reliable Change Index in the Evaluation of Joint Space Loss.
Parsons, CM, Judge, A, Leyland, K, Bruyère, O, Petit Dop, F, Chapurlat, R, Reginster, JY, Edwards, MH, Dennison, EM, Cooper, C, et al
Arthritis care & research. 2019;(2):300-307
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OBJECTIVE Osteoarthritis-related changes in joint space measurements over time are small and sensitive to measurement error. The Reliable Change Index (RCI) determines whether the magnitude of change observed in an individual can be attributed to true change. This study aimed to examine the RCI as a novel approach to estimating osteoarthritis progression. METHODS Data were from 167 men and 392 women with knee osteoarthritis (diagnosed using the American College of Rheumatology criteria) randomized to the placebo arm of the 3-year Strontium Ranelate Efficacy in Knee Osteoarthritis trial (SEKOIA) and assessed annually. The RCI was used to determine whether the magnitude of change in joint space width (JSW) on radiographs between study years was likely to be true or due to measurement error. RESULTS Between consecutive years, 57-69% of participants had an apparent decrease (change <0) in JSW, while 31-43% of participants had annual changes indicating improvement in JSW. The RCI identified JSW decreases in only 6.0% of patients between baseline and year 1, and in 4.5% of patients between the remaining study years. The apparent increases in JSW were almost eliminated between baseline and year 1, and between years 1 and 2 only 1.3% of patients had a significant increase, dropping to 0.9% between years 2 and 3. CONCLUSION The RCI provides a method to identify change in JSW, removing many apparent changes that are likely to be due to measurement error. This method appears to be useful for assessing change in JSW from radiographs in clinical and research settings.
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Time-course changes associated with PA lumbar mobilizations on lumbar and hamstring range of motion: a randomized controlled crossover trial.
Chesterton, P, Evans, W, Livadas, N, McLaren, SJ
The Journal of manual & manipulative therapy. 2019;(2):73-82
Abstract
OBJECTIVE We aimed to compare the post-intervention time-course changes in active knee extension (AKE) and active lumbar flexion (ALF) range of motion in response to unilateral posterior-anterior (UPA) mobilizations of the lumbar spine (L4/5 zygapophyseal). METHODS Twenty-four asymptomatic participants (maleness: 0.58, age [mean ± standard deviation]: 32 ± 8 years, body mass index 25.9 ± 2.6 kg m2) were recruited to a fully controlled crossover trial. Following either the intervention (L4/5 zygapophyseal mobilizations) or control, participants immediately performed the AKE and ALF tests, which were also performed at baseline. Subsequent tests were made at intervals of 5, 10, 15, 20, 25, 30, 45 and 60 min. RESULTS After adjustment for baseline (mean AKE: 37.2° from full extension, mean ALF: 14.37 cm), sex and age, UPA lumbar mobilizations had a most likely moderate effect on AKE (9.8° closer to full extension; ±1.9) and a likely moderate effect on ALF (1.34 cm; ±90% confidence limits 0.43). The magnitude of the AKE effect became most likely small 20-min posttreatment (5.3; ±1.7) and possibly small/possibly trivial 60-min posttreatment (2.1; ±1.4). For ALF, the magnitude of the effect became most likely small 15-min posttreatment (0.76; ±0.25), possibly small/possibly trivial 25-min posttreatment (0.38; ±0.18) and likely trivial 60-min posttreatment (0.26; ±1.8). DISCUSSION UPA lumbar mobilizations increased lumbar Range of Motion and hamstring extensibility by a moderate magnitude, with the effect reducing after 10-20-min posttreatment. Clinicians should consider these time-course changes when applying UPA lumbar mobilizations. Clinical Trials Registry: NCT03273400 Evidence Level: 2b.
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Comparable bone union progression after opening wedge high tibial osteotomy using allogenous bone chip or tri-calcium phosphate granule: a prospective randomized controlled trial.
Lee, DY, Lee, MC, Ha, CW, Kyung, HS, Kim, CW, Chang, MJ, Han, HS
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2019;(9):2945-2950
Abstract
PURPOSE The purpose of this study is to compare the progression rate of bone union and clinical outcomes of opening wedge high tibial osteotomy (OWHTO) using allogenous bone chip or tri-calcium phosphate (TCP) granule as bone graft materials. The hypothesis was that the bone union progression in OWHTOs using TCP granule grafts would be comparable to that of OWHTOs using allogenous bone chip grafts. METHODS Between 2011 and 2013, 54 patients who had undergone OWHTO for genu varum and osteoarthritis were randomized to one of the two groups at five centres. TCP granule was used to fill the defect in 27 patients and lyophilized allogenous bone chip was used in the other 27 patients. The degree of bone union was classified on a five-point scale and evaluated using plain radiographs of the knee at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, pain Visual Analogue Scale (VAS) score and complications were also evaluated. RESULTS The highest degree of bone union observed at 6 and 12 months postoperatively was grade 4, and the number of cases of union progression at each time-point was not significantly different between the two groups (p > 0.05). WOMAC and pain VAS scores also showed no differences between the two groups. No complications were observed during the 12-month period following OWHTO in either group. CONCLUSION OWHTO using TCP granule bone substitute showed similar bone union rates and clinical outcomes compared to allogenous bone chip grafts. TCP granule can be used as bone substitutes instead of allogenous bone chip grafts in OWHTO. LEVEL OF EVIDENCE Level 1.
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Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength, Morphology, Physiology, and Knee Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: Protocol for a Randomized Clinical Trial.
Erickson, LN, Lucas, KCH, Davis, KA, Jacobs, CA, Thompson, KL, Hardy, PA, Andersen, AH, Fry, CS, Noehren, BW
Physical therapy. 2019;(8):1010-1019
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BACKGROUND Despite best practice, quadriceps strength deficits often persist for years after anterior cruciate ligament reconstruction. Blood flow restriction training (BFRT) is a possible new intervention that applies a pressurized cuff to the proximal thigh that partially occludes blood flow as the patient exercises, which enables patients to train at reduced loads. This training is believed to result in the same benefits as if the patients were training under high loads. OBJECTIVE The objective is to evaluate the effect of BFRT on quadriceps strength and knee biomechanics and to identify the potential mechanism(s) of action of BFRT at the cellular and morphological levels of the quadriceps. DESIGN This will be a randomized, double-blind, placebo-controlled clinical trial. SETTING The study will take place at the University of Kentucky and University of Texas Medical Branch. PARTICIPANTS Sixty participants between the ages of 15 to 40 years with an ACL tear will be included. INTERVENTION Participants will be randomly assigned to (1) physical therapy plus active BFRT (BFRT group) or (2) physical therapy plus placebo BFRT (standard of care group). Presurgical BFRT will involve sessions 3 times per week for 4 weeks, and postsurgical BFRT will involve sessions 3 times per week for 4 to 5 months. MEASUREMENTS The primary outcome measure was quadriceps strength (peak quadriceps torque, rate of torque development). Secondary outcome measures included knee biomechanics (knee extensor moment, knee flexion excursion, knee flexion angle), quadriceps muscle morphology (physiological cross-sectional area, fibrosis), and quadriceps muscle physiology (muscle fiber type, muscle fiber size, muscle pennation angle, satellite cell proliferation, fibrogenic/adipogenic progenitor cells, extracellular matrix composition). LIMITATIONS Therapists will not be blinded. CONCLUSIONS The results of this study may contribute to an improved targeted treatment for the protracted quadriceps strength loss associated with anterior cruciate ligament injury and reconstruction.
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Can we improve cognitive function among adults with osteoarthritis by increasing moderate-to-vigorous physical activity and reducing sedentary behaviour? Secondary analysis of the MONITOR-OA study.
Falck, RS, Best, JR, Li, LC, Chan, PCY, Feehan, LM, Liu-Ambrose, T
BMC musculoskeletal disorders. 2018;(1):447
Abstract
BACKGROUND Preliminary evidence suggests osteoarthritis is a risk factor for cognitive decline. One potential reason is 87% of adults with osteoarthritis are inactive, and low moderate-to-vigorous physical activity and high sedentary behaviour are each risk factors for cognitive decline. Thus, we investigated whether a community-based intervention to increase moderate-to-vigorous physical activity and reduce sedentary behaviour could improve cognitive function among adults with osteoarthritis. METHODS This was a secondary analysis of a six month, proof-of-concept randomized controlled trial of a community-based, technology-enabled counselling program to increase moderate-to-vigorous physical activity and reduce sedentary behaviour among adults with knee osteoarthritis. The Immediate Intervention (n = 30) received a Fitbit® Flex™ and four bi-weekly activity counselling sessions; the Delayed Intervention (n = 31) received the same intervention two months later. We assessed episodic memory and working memory using the National Institutes of Health Toolbox Cognition Battery. Between-group differences (Immediate Intervention vs. Delayed Intervention) in cognitive performance were evaluated following the primary intervention (i.e., Baseline - 2 Months) using intention-to-treat. RESULTS The intervention did not significantly improve cognitive function; however, we estimated small average improvements in episodic memory for the Immediate Intervention vs. Delayed Intervention (estimated mean difference: 1.27; 95% CI [- 9.27, 11.81]; d = 0.10). CONCLUSION This small study did not show that a short activity promotion intervention improved cognitive health among adults with osteoarthritis. However, the effects of increased moderate-to-vigorous physical activity and reduced sedentary behaviour are likely to be small and thus we recommend subsequent studies use larger sample sizes and measure changes in cognitive function over longer intervals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Protocol Registration System: NCT02315664 ; registered 12 December, 2014; https://clinicaltrials.gov/ct2/show/NCT02315664?cond=NCT02315664&rank=1.