The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial

Stian Langgård Jørgensen; Per Aagaard; Marie Bagger Bohn; Peter Hansen; Per Møller Hansen; Carsten Holm; Louise Mortensen; Mette Garval; Lisa Urup Tønning; Inger Mechlenburg

doi:10.1111/sms.14750

The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial

Stian Langgård Jørgensen^*
, Per Aagaard
, Marie Bagger Bohn
, Peter Hansen
, Per Møller Hansen
, Carsten Holm
, Louise Mortensen
, Mette Garval
, Lisa Urup Tønning
, Inger Mechlenburg

^*Corresponding author for this work

Regionshospitalet Horsens
Aarhus University
Regionshospitalet Silkeborg
Aarhus University Hospital

Research output: Contribution to journal › Journal article › Research › peer-review

68 Downloads (Pure)

Abstract

The trial aimed to examine the effect of eight weeks preoperative low-load blood flow restricted resistance training (BFR-RT) on physical function, lower limb strength, and patient-reported outcomes in knee OA patients 3 and 12 months after total knee arthroplasty (TKA) compared with preoperative usual care. An assessor blinded randomized controlled trial (RCT) was conducted. Eighty-six patients scheduled for TKA who were allocated to 8 weeks BFR-RT on the affected leg 3x/week or preoperative usual care involving no exercise (CON). Primary outcome: 30-s sit to stand (30STS). Secondary outcomes: Timed Up&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), ~3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively. Trial Registration: NCT04081493.

Original language	English
Article number	e14750
Journal	Scandinavian Journal of Medicine & Science in Sports
Volume	34
Issue number	11
Number of pages	17
ISSN	0905-7188
DOIs	https://doi.org/10.1111/sms.14750
Publication status	Published - Nov 2024

Funding

This work was supported by grants from the Health Research Foundation of Central Denmark Region, Aase & Ejnar Danielsens Foundation, Nis-Hanssens Mindes legat, The Family Hede Nielsen Foundation, Brother's Hartmann Foundation, Augustinus Foundation, William Demant Foundation, The Danish Association of Physiotherapy Foundation. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or conclusions of this trial.

Keywords

Humans
Arthroplasty, Replacement, Knee/rehabilitation
Male
Female
Muscle Strength/physiology
Aged
Patient Reported Outcome Measures
Middle Aged
Osteoarthritis, Knee/surgery
Resistance Training/methods
Range of Motion, Articular
Lower Extremity/blood supply
Blood Flow Restriction Therapy
Postoperative Period
Preoperative Exercise
prehabilitation
exercise medicine
occlusion training
physical function

Documents & Links

10.1111/sms.14750Licence: CC BY

Open access versionFinal published version, 385 KBLicence: CC BY

SDU Link

Check access to the material in SDU Library's search engine

Cite this

Jørgensen, S. L., Aagaard, P., Bohn, M. B., Hansen, P., Hansen, P. M., Holm, C., Mortensen, L., Garval, M., Tønning, L. U., & Mechlenburg, I. (2024). The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial. Scandinavian Journal of Medicine & Science in Sports, 34(11), Article e14750. https://doi.org/10.1111/sms.14750

@article{318b95fdb21b438c8639e77ba7c9b416,

title = "The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial",

abstract = "The trial aimed to examine the effect of eight weeks preoperative low-load blood flow restricted resistance training (BFR-RT) on physical function, lower limb strength, and patient-reported outcomes in knee OA patients 3 and 12 months after total knee arthroplasty (TKA) compared with preoperative usual care. An assessor blinded randomized controlled trial (RCT) was conducted. Eighty-six patients scheduled for TKA who were allocated to 8 weeks BFR-RT on the affected leg 3x/week or preoperative usual care involving no exercise (CON). Primary outcome: 30-s sit to stand (30STS). Secondary outcomes: Timed Up\&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), \textasciitilde{}3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively. Trial Registration: NCT04081493.",

keywords = "Humans, Arthroplasty, Replacement, Knee/rehabilitation, Male, Female, Muscle Strength/physiology, Aged, Patient Reported Outcome Measures, Middle Aged, Osteoarthritis, Knee/surgery, Resistance Training/methods, Range of Motion, Articular, Lower Extremity/blood supply, Blood Flow Restriction Therapy, Postoperative Period, Preoperative Exercise, prehabilitation, exercise medicine, occlusion training, physical function",

author = "J{\o}rgensen, \{Stian Langg{\aa}rd\} and Per Aagaard and Bohn, \{Marie Bagger\} and Peter Hansen and Hansen, \{Per M{\o}ller\} and Carsten Holm and Louise Mortensen and Mette Garval and T{\o}nning, \{Lisa Urup\} and Inger Mechlenburg",

year = "2024",

month = nov,

doi = "10.1111/sms.14750",

language = "English",

volume = "34",

journal = "Scandinavian Journal of Medicine \& Science in Sports",

issn = "0905-7188",

publisher = "Wiley",

number = "11",

}

Jørgensen, SL, Aagaard, P, Bohn, MB, Hansen, P, Hansen, PM, Holm, C, Mortensen, L, Garval, M, Tønning, LU & Mechlenburg, I 2024, 'The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial', Scandinavian Journal of Medicine & Science in Sports, vol. 34, no. 11, e14750. https://doi.org/10.1111/sms.14750

The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial. / Jørgensen, Stian Langgård; Aagaard, Per; Bohn, Marie Bagger et al.
In: Scandinavian Journal of Medicine & Science in Sports, Vol. 34, No. 11, e14750, 11.2024.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: A Randomized Controlled Trial

AU - Jørgensen, Stian Langgård

AU - Aagaard, Per

AU - Bohn, Marie Bagger

AU - Hansen, Peter

AU - Hansen, Per Møller

AU - Holm, Carsten

AU - Mortensen, Louise

AU - Garval, Mette

AU - Tønning, Lisa Urup

AU - Mechlenburg, Inger

PY - 2024/11

Y1 - 2024/11

N2 - The trial aimed to examine the effect of eight weeks preoperative low-load blood flow restricted resistance training (BFR-RT) on physical function, lower limb strength, and patient-reported outcomes in knee OA patients 3 and 12 months after total knee arthroplasty (TKA) compared with preoperative usual care. An assessor blinded randomized controlled trial (RCT) was conducted. Eighty-six patients scheduled for TKA who were allocated to 8 weeks BFR-RT on the affected leg 3x/week or preoperative usual care involving no exercise (CON). Primary outcome: 30-s sit to stand (30STS). Secondary outcomes: Timed Up&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), ~3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively. Trial Registration: NCT04081493.

AB - The trial aimed to examine the effect of eight weeks preoperative low-load blood flow restricted resistance training (BFR-RT) on physical function, lower limb strength, and patient-reported outcomes in knee OA patients 3 and 12 months after total knee arthroplasty (TKA) compared with preoperative usual care. An assessor blinded randomized controlled trial (RCT) was conducted. Eighty-six patients scheduled for TKA who were allocated to 8 weeks BFR-RT on the affected leg 3x/week or preoperative usual care involving no exercise (CON). Primary outcome: 30-s sit to stand (30STS). Secondary outcomes: Timed Up&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), ~3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively. Trial Registration: NCT04081493.

KW - Humans

KW - Arthroplasty, Replacement, Knee/rehabilitation

KW - Male

KW - Female

KW - Muscle Strength/physiology

KW - Aged

KW - Patient Reported Outcome Measures

KW - Middle Aged

KW - Osteoarthritis, Knee/surgery

KW - Resistance Training/methods

KW - Range of Motion, Articular

KW - Lower Extremity/blood supply

KW - Blood Flow Restriction Therapy

KW - Postoperative Period

KW - Preoperative Exercise

KW - prehabilitation

KW - exercise medicine

KW - occlusion training

KW - physical function

U2 - 10.1111/sms.14750

DO - 10.1111/sms.14750

M3 - Journal article

C2 - 39461901

SN - 0905-7188

VL - 34

JO - Scandinavian Journal of Medicine & Science in Sports

JF - Scandinavian Journal of Medicine & Science in Sports

IS - 11

M1 - e14750

ER -