Rostron Zachary P J, Zacharias Anita, Semciw Adam I, Kingsley Michael, Pizzari Tania, Woodley Stephanie J, Green Rodney
Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Edwards Rd, Flora Hill, PO Box 199, Bendigo, VIC, 3552, Australia.
Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health La Trobe University, Bundoora, VIC, Australia.
BMC Musculoskelet Disord. 2022 Oct 29;23(1):944. doi: 10.1186/s12891-022-05907-4.
People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis.
Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time.
In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention.
Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles.
Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017.
髋骨关节炎患者通常会接受教育和锻炼相结合的方式来解决肌肉萎缩和无力问题。评估锻炼计划对该人群肌肉结构或功能疗效的证据有限。本研究的目的是评估有针对性的抗阻运动对轻至中度髋骨关节炎患者臀肌肥大和力量的影响。
从一项多中心、双盲临床试验的单个站点招募的27名经放射学确诊为髋骨关节炎的参与者被随机分配接受为期12周的针对性臀肌干预或假干预。使用磁共振成像和手持测力计来确定臀肌体积、脂肪浸润和髋部肌肉力量的变化。对于臀肌体积和力量结果，进行了方差分析的混合模型分析。使用具有固定效应参数估计的一般线性模型（方差分析）来评估性别仅对患侧肢体臀肌大小和力量的影响。对于肌肉脂肪指数，使用混合方法方差分析来评估组间差异和随时间的变化。
在针对性干预组中，双下肢的臀小肌体积从基线到干预后均增加（合并平均差异：0.06 cm/kg，95%置信区间：0.01至0.11），而假干预组没有变化（时间×组效应：P = 0.025）。臀中肌、臀大肌和阔筋膜张肌体积随时间没有显著变化。两组髋部力量（外展、内收、屈曲、伸展、外旋和内旋）的改善相似（时间主效应：P≤0.042）。针对性干预后脂肪浸润减少的模式一致，尽管不显著。
有针对性的抗阻运动导致了臀小肌肥大，但两组的髋部力量均有所改善。提供髋骨关节炎康复计划的临床医生可能会考虑实施有针对性的锻炼计划，以减轻与疾病相关的臀肌变化。
澳大利亚新西兰临床试验注册中心，ID：ACTRN12617000970347。于2017年7月5日前瞻性注册。
