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Total Knee ReplacementNCT04081493

The Efficacy of Low-load Blood Flow Restricted Resistance Before TKR

A study testing Low-load blood flow restricted exercise in people with Total Knee Replacement, run by University of Aarhus at 3 sites in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary aim of this study is to investigate the efficacy of 8 weeks of Low-load blood flow restricted exercise (BFRE) compared to receiving standard care only (no preoperative training) before total knee replacement (TKR) on postoperative 30-seconds chair stand test (30s-CST). Read more about this study

Who is it for?
Ages 50 years and olderHealthy volunteers can take part
Conditions the study is for
Total Knee Replacement
What is being tested?
Low-load blood flow restricted exercise
Could I receive a placebo?
No, everyone receives an active treatment
How many people
86 participants
Where
3 sitesDenmark
Study dates
17 Sep 2019to 1 Apr 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Patients ≥ 50 years scheduled for TKA at Horsens- or Silkeborg Regional Hospital.

Who cannot join

  • Severe cardiovascular diseases (New York Heart Association class III and IIII), previous stroke incident, thrombosis incident
  • Traumatic nerve injury in affected limb
  • Unregulated hypertension (Systolic ≥180 or diastolic ≥110 mmHg)
  • Spinal cord injury
  • Pregnancy
  • Planned other lower limb surgery within 12 months
Show all 10Show fewer
  • Cancer diagnosis and currently undergoing chemo-, immuno-, or radiotherapy
  • Inadequacy in written and spoken Danish
  • an existing prosthesis in the index limb
  • living more than 45 minutes from either Horsens Regional Hospital or Silkeborg Regional Hospital.

Trial locations and contacts

3 sites in 1 country.

Denmark3 sites
  • Aarhus University Hosspital

    Aarhus, Aarhus N, 8200

  • Horsens Regional Hospital

    Horsens, 8600

  • Silkeborg Regional Hospital

    Silkeborg, 8600

Other trials in Denmark

About this study

Official title: The Efficacy of Low-load Blood Flow Restricted Resistance Exercise in Patients With Knee Osteoarthritis Scheduled for Total Knee Arthroplasty: A Multicenter, Randomized Controlled Trial

The primary aim of this study is to investigate the efficacy of 8 weeks of Low-load blood flow restricted exercise (BFRE) compared to receiving standard care only (no preoperative training) before total knee replacement (TKR) on postoperative 30-seconds chair stand test (30s-CST). We hypothesize that 8 weeks of preoperative BFRE will increase chair stand performance 3 months postoperatively. Secondary aims are to investigate the efficacy of 8 weeks of preoperative BFRE compared to receiving standard care only on changes in muscle strength 3 months after TKR and investigate associations to functional capacity and quality of life. Furthermore, it will be investigated if 8 weeks of BFRE induces muscle hypertrophy and increases satellite cell and myonuclei content of the vastus lateralis muscle.

Read the detailed description

BFRE is resistance training with low loads (30% 1repetition maximum (RM) performed with concurrent partial blood flow restriction by means of pneumatic cuff compression around the working limb.

Group 1 (BFRE):

BFRE group: Will perform 3/weekly supervised BFRE sessions for 8 weeks from a physiotherapist educated in administering BFRE. Each session will consist of a 10-min warm up followed by two different unilateral lower-limb resistance training exercises: leg press and knee extension. Each exercise will be performed with the affected lower limb only and consist of 4 rounds interspaced by 30 seconds of rest. 1st round: 30 repetitions (reps); 2nd round: 15 reps; 3rd round: 15 reps; 4th round: until exhaustion. Between each exercise the patients will rest for 5 minutes without blood flow restriction.

Patients will rest in a standardized resting position between each set to maintain the desired resting cuff-pressure.

The occlusion pressure will be set at 60% of total limb occlusion pressure and starting load intensity will be 30% 1repetition maximum (1RM) in both exercises. If patients can perform more than 15 repetitions in the 4th exercise set, the exercise load will be increased with the minimum extra load possible.

Group 2 (control Group):

CON group: Will follow standard procedures before a TKA and be encouraged to live their lives as usual up until TKA.

The study is a multicenter (2 sites), randomized (allocation 1:1), assessor blinded, controlled trial Outcomes will be measured at baseline (9-10 weeks before surgery), in the week of surgery and 3- and 12 months postoperatively. Muscle biopsies will be taken from all patients undergoing surgery at Horsens Regional Hospital. Muscle biopsies will be taken at baseline, during surgery and 3 months postoperatively.

The 12 months follow-up assessment will be analyzed and presented in papers during a subsequent Post Doc-period.

All patients will be scheduled to receive TKR and receive a standard multimodal surgical program with standardized perioperative care. Specifically, all patients will be invited to a preoperative information meeting 2-3 weeks prior to surgery where nurses, surgeons, and physiotherapists will be providing detailed information about pain management, nutrition, the surgical procedure (i.e. basic knowledge about a prosthesis, risks related to smoking, restrictions related to living with a TKR, long-term results, and living with a TKR), physical activity, postoperative home-based rehabilitation, load-management, etc.

On the day of surgery patients will be hospitalized at one of the two orthopedic departments and TKR procedures will be performed by an orthopedic surgeon. The day after surgery patients will be trained once or twice per day by a physiotherapist towards fulfilling the following discharge criterions: independency in in-and-out of bed and sit-to-stand activities, independency in walking and stair-negotiation with crutches, ADL activities, and home-based exercises during the hospitalization period. Patients will generally be discharged within ~1-2 days after fulfilling all the above discharge criteria. After discharge, all patients will receive a standard home-based rehabilitation program aimed at increasing knee mobility and lower extremity muscle strength. However, if considered necessary by the physiotherapist in charge of the patient, patients can receive additional supervised knee-specific exercise therapy at private physiotherapy clinics, municipal rehabilitation centers, or specialized hospital-based rehabilitation.

Being tested
Low-load blood flow restricted exercise
Keywords
Low-load blood flow restricted exercise, Preconditioning, Functional capacity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Low-load blood flow restricted exerciseOther

    Leg press and knee extension exercise 3 times per week for 8 weeks. Repetition scheme: 30-15-15-until exhaustion interspaced by 30 sec rest. 5 min "free-flow" rest between exercises

Study groups in NCT04081493
Study groupRoleWhat they receive
Group 1 (BFRE)ExperimentalLow-load blood flow restricted exercise 3/weekly for 8 weeks before TKR 10-min warm-up followed by unilateral leg press and unilateral knee extension
Receives: Other: Low-load blood flow restricted exercise
Group 2 (CON)No interventionNo training before TKR

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 30-seconds chair stand test (30-sec CST)

    The 30s-CST measures the number of sit-to-stand repetitions completed within 30 seconds. Patients will be instructed to perform a sit-to-stand movement starting from a seated position (seat height 43 cm without armrests) having the feet placed flat on the floor shoulder width apart, and arms crossed on chest to a standing position (hip and knee joints fully extended) repeated as many times as possible for 30 seconds.

    Measured: change in 30-sec CST from baseline to 3 months after surgery

Secondary outcomes (10)
  1. Timed Up & Go

    The TUG assesses the time required for patients to stand from a chair (seat height 46 cm) walk around a tape mark 3 meters away and sit into the chair at return.

    Measured: Measured at baseline, in the week of surgery, 3 months after surgery, and 12 months after surgery

  2. 4x10 meter fast-paced walk test (40m-FWT)

    The 40m fast-paced walk test (40m-FWT) measures the total time taken to walk 4 x 10 m excluding turns (meter/sec).

    Measured: Measured at baseline, in the week of surgery, 3 months after surgery, and 12 months after surgery

  3. 1RM leg press strength

    1 Repetition maximum (RM) is the maximal load (kg) a patient is able to concentrically press in the leg press machine. The 1RM will be estimated from a 5-8RM leg press test. The 1RM will be calculated as [1RM = load (kg)/1.0278-0.0278·number of repetitions)

    Measured: Measured at baseline, in the week of surgery, 3 months after surgery, and 12 months after surgery

  4. 1RM knee extension strength

    1 Repetition maximum (RM) is the maximal load (kg) a patient is able to concentrically lift in the knee extension machine. The 1RM will be estimated from a 5-8RM leg press test. The 1RM will be calculated as [1RM = load (kg)/1.0278-0.0278·number of repetitions)

    Measured: Measured at baseline, in the week of surgery, 3 months after surgery, and 12 months after surgery

  5. Isometric knee extensor strength

    Isometric knee extensor muscle strength will be assed with the participants seated on a examination table with knees and hip positioned at 90 degree flexion. Assessment of muscle strength will be performed with a hand-held dynamometer, fixed with an adjustable rigid belt to the examination table.

    Measured: Measured at baseline, in the week of surgery, 3 months after surgery, and 12 months after surgery

  6. Isometric knee flexor strength

    Isometric knee flexor muscle strength will be assed with the participants seated on a examination table with knees and hip positioned at 90 degree flexion. Assessment of muscle strength will be performed with a hand-held dynamometer, fixed with an adjustable rigid belt to the examination table.

    Measured: Measured at baseline, in the week of surgery, 3 months after surgery, and 12 months after surgery

  7. Muscle biopsy sampling and analysis - myofiber morphology (cross sectional area, fiber type composition, myonuclei number) and myogenic stemm cell (satellite cell) content

    needle biopsies (100-150 mg) will be obtained from the vastus lateralis muscle of patients undergoing TKR at Horsens Regional Hospital

    Measured: Measured at baseline, in the week of surgery, and 3 months after surgery

  8. Knee disability and Osteoarthritis Outcome Score (KOOS)

    KOOS is a patient-administered knee specific questionnaire comprising five subscales Pain; Symptoms; Activities of daily living; Sport \& Recreation; and Knee-Related Quality of Life.

    Measured: Measured at baseline, in the week of surgery, 6 weeks after surgery, 3 months after surgery, and 12 months after surgery

  9. EuroQol Group 5-dimension (EQ-5D-5L)

    The EQ-5D-L5 is a self-completion questionnaire consisting of two parts; first part of the EQ-5D-5L comprises five dimensions involving mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

    Measured: Measured at baseline, in the week of surgery, 6 weeks after surgery, 3 months after surgery, and 12 months after surgery

  10. Adverse events

    Adverse events will be defined as unpredicted or unintended events, signs, or disease occurring during the period from inclusion until the 3-month follow-up (primary end-point) resulting in contact with the healthcare system (hospital or general practitioner) independent of whether or not the event is related to the intervention or outcome assessments

    Measured: 3 months after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Sep 2019
  2. Study start17 Sep 2019
  3. Primary completion10 Jun 2023
  4. Study completion1 Apr 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
86 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04081493
Sponsor's protocol ID
Okklusionsprojektet
Status last verified
Mar 2024
First submitted
29 Aug 2019
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Horsens Regional is responsible for handling all personal data provided by both sites in accordance to the Clinical Trial Agreement and the EU General Data Protection Regulation (GDPR)

Publications

  • Jorgensen SL, Aagaard P, Bohn MB, Hansen P, Hansen PM, Holm C, Mortensen L, Garval M, Tonning LU, Mechlenburg I. 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. Scand J Med Sci Sports. 2024 Nov;34(11):e14750. doi: 10.1111/sms.14750.

    PubMed 39461901
  • Langgard Jorgensen S, Mechlenburg I, Bagger Bohn M, Aagaard P. Sit-to-stand power predicts functional performance and patient-reported outcomes in patients with advanced knee osteoarthritis. A cross-sectional study. Musculoskelet Sci Pract. 2024 Feb;69:102899. doi: 10.1016/j.msksp.2023.102899. Epub 2023 Dec 17.

    PubMed 38141496
  • Jorgensen SL, Bohn MB, Aagaard P, Mechlenburg I. Efficacy of low-load blood flow restricted resistance EXercise in patients with Knee osteoarthritis scheduled for total knee replacement (EXKnee): protocol for a multicentre randomised controlled trial. BMJ Open. 2020 Oct 1;10(10):e034376. doi: 10.1136/bmjopen-2019-034376.

    PubMed 33004382

Questions about this trial

What is this clinical trial studying?

A study testing Low-load blood flow restricted exercise in people with Total Knee Replacement, run by University of Aarhus at 3 sites in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

30-seconds chair stand test (30-sec CST) (time frame: change in 30-sec CST from baseline to 3 months after surgery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04081493, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2024.

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