Effects of neuromuscular control and strengthening exercises on MRI-measured thigh tissue composition and muscle properties in people with knee osteoarthritis – an exploratory secondary analysis from a randomized controlled trial

•First RCT to assess exercise and muscle fat in and around muscles in arthritis.•Adding strength training to an established exercise program has overlapping effects.•21–25 % reductions in fat around muscles with/without added strength training.•12 % increase in whole-muscle specific strength with/wi...

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Published in:	Seminars in arthritis and rheumatism 2024-04, Vol.65, p.152390-152390, Article 152390
Main Authors:	Holm, Pætur M., Blankholm, Anne Dorte, Nielsen, Jakob L., Bandholm, Thomas, Wirth, Wolfgang, Wisser, Anna, Kemnitz, Jana, Eckstein, Felix, Schrøder, Henrik M., Wernbom, Mathias, Skou, Søren T.
Format:	Article
Language:	eng
Subjects:	Exercise Therapy Humans Knee Magnetic Resonance Imaging Muscle Strength - physiology Osteoarthritis Osteoarthritis, Knee - diagnostic imaging Osteoarthritis, Knee - therapy Quadriceps Quadriceps Muscle - diagnostic imaging Reumatologi och inflammation Rheumatology and Autoimmunity Strength training Thigh - diagnostic imaging
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Summary:	•First RCT to assess exercise and muscle fat in and around muscles in arthritis.•Adding strength training to an established exercise program has overlapping effects.•21–25 % reductions in fat around muscles with/without added strength training.•12 % increase in whole-muscle specific strength with/without added strength training. To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA). In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance. At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST. Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA.
ISSN:	0049-0172 1532-866X 1532-866X