From the Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan (HM, NS); and Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas (HM, NAS, KGR).
Am J Phys Med Rehabil. 2020 Jan;99(1):56-64. doi: 10.1097/PHM.0000000000001319.
The aim of the study was to assess the effectiveness of a hybrid training system with walking that simultaneously applies electrical stimulation to the knee extensors/flexors during walking in obese women with knee pain.
This is a randomized, single-blind (assessor), controlled trial. Twenty-eight obese women with knee pain were randomized to 12 weeks of biweekly walking with either hybrid training system with walking or with transcutaneous electrical nerve stimulation (control). Primary outcomes (maximum isokinetic knee extensor torque and maximum isokinetic knee flexor torque) and secondary outcomes (20-m walk time, chair-stand time, stair-climb time, knee pain, and knee-related quality life) were evaluated. Change-point regression analyses were used to model the interaction for the primary outcomes. Two-sample t tests were used on pre-post change scores in secondary outcomes.
Knee extensor torque increased significantly more in the hybrid training system with walking group than the control group when baseline knee extensor torque was greater than 57.2 Nm (P = 0.0033). When baseline knee flexor torque was at 30 or 50 Nm, there was a trend toward greater increase in the hybrid training system with walking group than the control group (P = 0.0566, P = 0.0737, respectively). There were no significant differences between groups in secondary outcomes.
These results suggest that hybrid training system with walking is effective for improving knee extensor torque in obese women with knee pain. However, the superiority of hybrid training system with walking may vary depending on baseline knee muscle strength.
本研究旨在评估一种混合训练系统与步行相结合的效果，该系统在肥胖膝痛女性行走时同时对伸膝/屈膝肌施加电刺激。
这是一项随机、单盲（评估者）、对照试验。28 名肥胖膝痛女性被随机分为两组，分别接受 12 周的双周步行训练，一组为混合训练系统与步行结合，另一组为经皮神经电刺激（对照组）。主要结局（最大等速膝伸肌力矩和最大等速膝屈肌力矩）和次要结局（20 米步行时间、坐站时间、爬楼梯时间、膝关节疼痛和膝关节相关生活质量）进行评估。采用变化点回归分析对主要结局进行交互作用建模。采用两样本 t 检验对次要结局的前后变化得分进行分析。
当基线膝伸肌力矩大于 57.2 Nm 时，与对照组相比，混合训练系统与步行组的膝伸肌力矩显著增加（P = 0.0033）。当基线膝屈肌力矩为 30 或 50 Nm 时，混合训练系统与步行组的增加趋势较对照组更为明显（P = 0.0566，P = 0.0737）。两组在次要结局上无显著差异。
这些结果表明，混合训练系统与步行相结合对改善肥胖膝痛女性的膝伸肌力矩有效。然而，混合训练系统与步行的优越性可能因基线膝关节肌力的不同而有所差异。
