Annals of IM: Both Resistance Training and Neuromuscular Exercise Improved Function and Pain in Hip Osteoarthritis How was the trial designed?

Response: We conducted a clinical multicenter randomized controlled trial in which we compared an exercise program that is frequently used in clinical practice, neuromuscular exercise (NEMEX), to another promising exercise type, high-intensity progressive resistance training (PRT). We compared them in terms of their effectiveness for improving physical function and hip-related quality of life and for reducing hip pain.

The NEMEX program consisted of 10 low-to-moderate intensity exercises and emphazises to adjust each exercise to the capacity of the individual and the target mechanisms are to improve sensorimotor control and functional stability. The PRT program consisted of 5 high-intensity exercises in resistance training machines with an emphasis on maximizing exercise intensity (load/weight), while performing the concentric muscle contractions as-fast-as-possible while training to muscle failure. The target mechanisms of the PRT program was to increase muscle strength and power. What are the main findings?

Response: We found no difference in effect for physical function, pain or quality of life between NEMEX and PRT. In fact, the estimates for these effects were highly similar. However, PRT did seem to result in a slightly larger effect for muscle strength and muscle power. What should readers take away from your report?

Response: Since there was no difference in effect for the main clinical outcomes, patients can be encouraged to choose the type of exercise that they find most enjoyable and the one that is available to them, in terms of equipment and professional guidance. What recommendations do you have for future research as a result of this study?

Response: It would be interesting to see a large high-quality trial comparing aerobic exercise to resistance training. One prior trial has shown promising results of Nordic Walking (walking with walking sticks) but this trial had a very high drop-out rate from the Nordic Walking group, potentially introducing bias that could lead to an overestimation of this effect. But I think that aerobic exercise is worthwhile investigating. Is there anything else you would like to add? Any disclosures?

Response: I think it was quite surprising to see that PRT only led to a slightly greater increase in muscle strength and power compared to NEMEX. One possible explanation is that when people are very deconditioned, as is the case in this trial population, it seems that you don’t really need to exercise with a high intensity or volume in order to see substantial increases in muscle strength and muscle power.

Citation: Kjeldsen T, Skou ST, Dalgas U, Tønning LU, Ingwersen KG, Birch S, Holm PM, Frydendal T, Garval M, Varnum C, Bibby BM, Mechlenburg I. Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis : A Multicenter Cluster Randomized Controlled Trial. Ann Intern Med. 2024 Apr 9. doi: 10.7326/M23-3225. Epub ahead of print. PMID: 38588540.

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Last Updated on April 11, 2024 by