Feasibility of Stationary Cycling with Pedal Force Visual Feedback Post-Total Knee Arthroplasty: Implications for Inter-Limb Deficits in Knee Joint Biomechanics.

The purpose of this study was to assess the biomechanical adaptations prompted by stationary cycling paired with visual feedback of vertical pedal reaction forces during both stationary cycling and overground walking for patients who underwent a total knee arthroplasty (TKA). Specifically, an emphasis on the inter-limb deficits in knee joint biomechanics were examined. Ten patients who underwent a TKA took part in an acute intervention with pre- and post-testing measurements of kinematics (240 Hz) and kinetics (1200 Hz) during stationary cycling and overground walking. The intervention phase consisted of six cycling sessions during which participants were provided with visual feedback of their bilateral peak vertical pedal reaction force, with instructions to maintain a symmetrical loading between limbs. A 2 × 2 (work rate/speed × time) repeated measures ANOVA (α = 0.05) was conducted on key outcome variables. Peak knee extension moment asymmetry during stationary cycling significantly improved (p = 0.038, η2p = 0.610) following the acute intervention. Walking velocities for both preferred (p = 0.001, d = 0.583) and fast (p = 0.002, d = 0.613) walking speeds displayed improvements from pre- to post-testing. Significant improvements in the total score (p = 0.009, d = 0.492) and ADL subscale score (p = 0.041, d = 0.270) for the Knee Injury and Osteoarthritis Outcome Score were present following the acute intervention. Stationary cycling with visual feedback may be beneficial post-TKA; however, further investigation is merited.

Medial and Lateral Tibiofemoral Compressive Forces in Patients Following Unilateral Total Knee Arthroplasty During Stationary Cycling.

Patients following unilateral total knee arthroplasty (TKA) display interlimb differences in knee joint kinetics during gait and more recently, stationary cycling. The purpose of this study was to use musculoskeletal modeling to estimate total, medial, and lateral tibiofemoral compressive forces for patients following TKA during stationary cycling. Fifteen patients of unilateral TKA, from the same surgeon, participated in cycling at 2 workrates (80 and 100 W). A knee model (OpenSim 3.2) was used to estimate total, medial, and lateral tibiofemoral compressive forces for replaced and nonreplaced limbs. A 2 × 2 (limb × workrate) and a 2 × 2 × 2 (compartment × limb × workrate) analysis of variance were run on the selected variables. Peak medial tibiofemoral compressive force was 23.5% lower for replaced compared to nonreplaced limbs (P = .004, G = 0.80). Peak medial tibiofemoral compressive force was 48.0% greater than peak lateral tibiofemoral compressive force in nonreplaced limbs (MD = 344.5 N, P < .001, G = 1.6) with no difference in replaced limbs (P = .274). Following TKA, patients have greater medial compartment loading on their nonreplaced compared to their replaced limbs and ipsilateral lateral compartment loading. This disproportionate loading may be cause for concern regarding exacerbating contralateral knee osteoarthritis.

Increased Q-factor increases medial compartment knee joint contact force during cycling.

As Q-Factor (QF: inter-pedal distance) is increased, the internal knee abduction moment (KAbM) also increases, however it is unknown if this increased KAbM is associated with increased medial compartment knee joint contact force in cycling. In the absence of in vivo measurement, musculoskeletal modeling simulations may provide a viable option for estimating knee joint contact forces in cycling. The primary purpose of this study was to investigate the effect of increasing QF on knee joint total (TCF), and medial (MCF) compartment contact force during ergometer cycling. The secondary purpose was to evaluate whether KAbM and knee extension moment are accurate predictors of MCF in cycling. Musculoskeletal simulations were performed to estimate TCF and MCF for sixteen participants cycling at an original QF (150 mm), and wide QF (276 mm), at 80 W and 80 rotations per minute. Paired samples t-tests were used to detect differences between QF conditions. MCF increased significantly, however, TCF did not change at wide QF. Peak knee extensor muscle force did not change at wide QF. Peak knee flexor muscle force was significantly reduced with wide QF. Regression analyses showed KAbM and knee extension moments explained 87.4% of the variance in MCF when considered alongside QF. The increase of MCF may be attributed to increased frontal-plane pedal reaction force moment arm. Future research may seek to implement QF modulation as a part of rehabilitation or training procedures utilizing cycling in cases where medial compartment joint loading is of importance.

Movement direction impacts knee joint kinematics during elliptical exercise at varying incline angles.

BACKGROUND: Elliptical trainers are a popular cardiovascular exercise for individuals with injuries or those post-operation. There is currently limited data on the impacts of direction while on elliptical trainers for knee joint kinematic risk factors. This study compared lower extremity kinematics between the forward and reverse direction at varying inclines on an elliptical trainer modified with converging footpath and reduced inter-pedal distance. METHODS: Twenty-four college age participants exercised on the modified elliptical in both directions at four ramp inclines: 6°, 12°, 25°, and 35°. Three-dimensional kinematics were collected for each direction and ramp incline. A 2 × 4 (direction × incline) repeated measures analysis of variance was run with an alpha of 0.05. Simple effects analysis was run with Bonferroni correction for significant interaction or main effect of ramp incline. RESULTS: The reverse direction had significantly greater peak knee valgus at 6° incline (mean difference [MD] = 1.35°, p < 0.014, d = 0.31) and 12° (MD = 2.41°, p < 0.001, d = 0.55), peak hip abduction at 6° (MD = 2.86°, p = 0.002, d = 0.49) and 12° (MD = 2.91°, p < 0.001, d = 0.51), but decreased peak knee flexion angles (p = 0.032) at all inclines. CONCLUSIONS: Individuals with knee pathologies such as knee osteoarthritis or anterior knee pain should exercise in the reverse direction at lower inclines. However, switching to the forward direction and/or increasing incline may increase quadriceps strength during a safe activity such as elliptical trainers.

Does saddle height influence knee frontal-plane biomechanics during stationary cycling?

INTRODUCTION: Cycling is a common modality for rehabilitation and exercise. However, there is a lack of information in the literature on the effects of saddle height adjustments on internal peak knee abduction moment, which is an important loading variable for the medial compartment of tibiofemoral joint for patients with knee osteoarthritis. The purpose of this study was to examine effects of saddle height on frontal-plane biomechanics of the knee during cycling. METHODS: Fourteen recreational cyclists (age: 57.1 ± 6.37 years) performed 2-min bouts of cycling at three saddle heights of 40°, 30° and 20° knee extension angle at bottom crank position, at two workrates of 80 and 120 W. Three-dimensional kinematic, kinetic, and electromyography data were collected and analyzed using a 3 × 2 (height × workrate) analysis of variance (ANOVA). RESULTS: There were no changes in internal knee abduction moment across saddle heights. Increases in saddle height from 40° to both 30° and 20° reduced the knee extension moment (d = 0.3 and 0.4, respectively, P = 0.012). Increases in workrate increased both knee abduction and extension moments (η2p = 0.75 and 0.88, respectively, P < 0.001 for both). CONCLUSIONS: Increased knee extension moment with decreased saddle height is likely to indicate increased knee joint load.

Knee joint biomechanics of patients with unilateral total knee arthroplasty during stationary cycling.

Stationary cycling is typically recommended following total knee arthroplasty (TKA) operations. However, knee joint biomechanics during cycling remains mostly unknown for TKA patients. Biomechanical differences between the replaced and non-replaced limb may inform applications of cycling in TKA rehabilitation. The purpose of this study was to examine the knee joint biomechanics of TKA patients during stationary cycling. Fifteen TKA participants cycled at 80 revolutions per minute and workrates of 80 W and 100 W while kinematics (240 Hz) and pedal reaction forces using a pair of instrumented pedals (1200 Hz) were collected. A 2x2 (limb × workrate) repeated measures ANOVA was run with an alpha of 0.05. Peak knee extension moment (KEM, p = 0.034) and vertical pedal reaction force (p = 0.038) were significantly reduced in the replaced limbs compared to non-replaced limbs by 21.3% and 5.3%, respectively. Peak KEM did not change for TKA patients with the increased workrate (p = 0.750). However, both peak hip extension moment (p = 0.009) and ankle plantarflexion moment (p = 0.017) increased due to increased workrate. Patients following TKA showed similar decreases in peak KEM and vertical pedal reaction force in their replaced compared to non-replaced limbs, as previously seen in gait. Patients of TKA may rely on their hip and ankle extensors to increases in workrate. Increasing intensity by 20 W did not exacerbate any inter-limb differences for peak KEM and vertical PRF.

The effects of a standard elliptical vs. a modified elliptical with a converging footpath on lower limb kinematics and muscle activity.

Elliptical trainers that increase the inter-pedal distance may have potential benefits for knee osteoarthritis by decreasing the amount of knee varus. Modifying elliptical trainers with a converging footpath and reduced inter-pedal distance may be beneficial for reducing anterior knee pathology risk by decreasing knee valgus angles. Twenty-one college students participated in a single testing session. Participants exercised on two different elliptical trainers, one modified with a converging footpath and reduced inter-pedal width, and a standard elliptical trainer. Participants exercised for 2 min at three ramps incline at 120 strides per minute and constant work rate. Three-dimensional kinematics and electromyography of the dominant lower limb were recorded. Multiple 2 × 3 (Elliptical x Incline) ANOVAs with Bonferroni corrections were used to compare the two elliptical trainers at each incline for kinematics and muscle activity. The modified elliptical trainer displayed significantly decreased peak knee valgus (p = 0.031, η p 2 = 0.234 ), peak knee flexion (p = 0.006, η p 2 = 0.246 ), and interactions for peak knee flexion (p = 0.001, η p 2 = 0.250 ) and vastus lateralis (p < 0.01, η p 2 = 0.380 ) muscle activity compared to the standard elliptical trainer. The decreased peak knee valgus and flexion angles could be beneficial for reducing long-term injury risk for anterior knee pathologies.

Creatine electrolyte supplement improves anaerobic power and strength: a randomized double-blind control study.

BACKGROUND: Creatine supplementation aids the Phosphagen system by increasing the amount of free creatine and phosphocreatine available to replenish adenosine triphosphate. The purpose of this study was to investigate the effects of a creatine and electrolyte formulated multi-ingredient performance supplement (MIPS) on strength and power performance compared to a placebo. Maximal strength along with total concentric work, mean rate of force development (mRFD), mean power, peak power, and peak force for both bench press and back squat were determined at pre-test and post-test separated by 6 weeks of supplementation. METHODS: Twenty-two subjects (6 females, 21 ± 2 yrs., 72.46 ± 11.18 kg, 1.72 ± 0.09 m) performed a one-repetition maximum (1RM) for back squat and bench press. Eighty percent of the subject's pre-test 1RM was used for a maximal repetition test to assess performance variables. Testing was separated by 6 weeks of supplementation of a MIPS dose per day in a double-blind fashion for comparison. A two-way mixed analysis of covariance (ANCOVA) was applied with an alpha level of 0.05. RESULTS: For their back squat 1RM, the MIPS group displayed significant increase of 13.4% (95% CI: 2.77, 23.8%) while placebo displayed a decrease of - 0.2% (95% CI: - 1.46, 2.87%) (p = 0.047, ηp2 = 0.201). The MIPS displayed a significant increase of 5.9% (95% CI: 2.5, 10.1%) and placebo displayed a non-significant increase of 0.7% (95% CI: - 3.49, 3.9%) in bench press maximal strength (p = 0.033,0.217). The MIPS group displayed a significant increase as well in total concentric work (26.5, 95% CI: 6.07, 46.87%, p = 0.008, ηp2 = 0.330) and mean power (17.9, 95% CI: 3.42, 32.46%, p = 0.003, ηp2 = 0.402) for the maximal repetition bench press test at 80% of their 1RM. CONCLUSIONS: The MIPS was found to be beneficial to recreationally trained individuals compared to a placebo. The greatest benefits are seen in bench press and back squat maximal strength as well as multiple repetition tests to fatigue during the bench press exercise.