Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 121: Does More Intense Strength Training Improve Function? (What a New Knee Replacement Study Found)

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Episode 121: Does More Intense Strength Training Improve Function? (What a New Knee Replacement Study Found) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  On the leg press using both legs, the added program
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  group increased the weight they could push by
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  about 34%, compared with about 15 % in the usual
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  rehabilitation group. Are you ready to get back
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  to what you love after knee replacement? The
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  Total Knee Success podcast is your trusted guide
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  with practical tips, evidence -based strategies,
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  and no fluff. It's not personal medical advice,
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  just solid education to help you manage pain.
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  regain mobility, and get back to living the life
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  you love. Let's dive in. Welcome back to the
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  Total Knee Success Podcast. I'm Michelle. Today
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  we're beginning a six -part series called What's
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  New in Knee Replacement Research. In each episode
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  we'll look at a research question, what the findings
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  mean, and how you can use that information. We're
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  starting with strength training after surgery.
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  Does lifting heavier weights help you do more
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  in everyday life? If you can push more weight
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  at the gym, you might expect getting out of a
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  low chair or walking to your seat at a ball game
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  to become easier too. So what happens when the
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  weight you can lift increases but your walking
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  improves less than someone following a different
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  program? That happened in a recent knee replacement
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  study. Both groups improved, but the added training
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  helped some abilities more than others. By the
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  end of this episode, you'll have a better idea
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  of what heavier strength training improved in
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  this particular study, how researchers tested
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  walking, and how to judge whether your program
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  is helping you do the things you want to do.
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  Researchers in the Netherlands wanted to find
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  out whether adding a demanding weight training
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  program and nutritional support to usual rehabilitation
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  would help people build more muscle, get stronger,
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  and move better after knee replacement. Alejandro
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  Monsey and colleagues published the result in
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  2026 in Medicine and Science in Sports and Exercise.
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  They reported results from 33 adults who had
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  received a first total knee replacement for osteoarthritis.
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  Their average age was about 70. The added program
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  began around eight weeks after surgery, continued
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  for 12 weeks, and ended roughly five months after
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  the operation. Participants were assigned by
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  chance to one of two groups. Everyone could continue
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  the care recommended by their own physical therapist
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  or doctor. One group also received supervised
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  weight training three times a week, nutritional
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  supplements, and advice about what they ate.
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  The other group continued usual rehabilitation.
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  Because several things were added together, the
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  study could assess that combination but couldn't
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  identify how much benefit came from the training
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  or the nutrition support separately. In the added
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  program, people trained both legs and other muscle
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  groups using weight machines. The resistance
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  increased gradually, with a trained researcher
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  supervising and adjusting the weights. By the
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  later sessions, the target was about 80 % of
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  the heaviest weight each person could lift once.
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  That is what the researchers meant by high intensity,
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  a relatively heavy weight for that person. The
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  study started well after the first weeks of healing,
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  and its training schedule and weights need to
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  be understood in that context. On the leg press
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  using both legs, the added program group increased
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  the weight they could push by about 34%, compared
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  with about 15 % in the usual rehabilitation group.
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  The researcher's analysis supported an extra
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  benefit from the added program on that test.
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  They also tested each leg separately. Both groups
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  became stronger in their surgical leg, but the
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  study didn't establish that the added program
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  helped that leg more. The extra strength benefit
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  was more evident in the leg that hadn't been
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  operated on. When you push a platform away with
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  both feet, either leg can contribute to the total
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  weight. Some participants reported relying more
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  on their non -surgical leg during these movements.
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  That could allow the weight on the machine to
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  increase while your surgical leg does less of
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  the work. A physical therapist can check how
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  you're using each leg and assess its strength
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  separately when appropriate. For walking, researchers
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  measured the distance each person could cover
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  in six minutes. On average, the usual rehabilitation
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  group added 85 meters to their distance, or about
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  279 feet. The group with the added program improved
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  by 43 meters, or about 141 feet. Both groups
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  walked farther by the end and the comparison
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  favored usual rehabilitation. Gaining more strength
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  on the two -leg press hadn't produced a bigger
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  improvement on the walking test. There were two
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  kinds of appointments in this study, regular
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  physical therapy visits and the extra supervised
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  weight training sessions. People following usual
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  rehabilitation attended more regular therapy
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  visits. People in the added program attended
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  fewer regular visits, alongside their three weight
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  training sessions each week. Their own therapists
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  decided what their usual care included, so the
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  groups differed in more than the weights they
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  lifted. The researchers suggested that the difference
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  in regular therapy might explain the walking
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  results, but the study couldn't establish whether
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  that was the reason. The researchers also timed
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  how long people took to stand up from a chair
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  five times. People in the added program became
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  faster, but their improvement wasn't enough to
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  establish that the program worked better than
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  usual rehabilitation for that task. The researchers
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  measured muscle size as well. Both groups gained
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  muscle without a demonstrated extra benefit from
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  the added program. It was a small study with
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  follow -up ending after the training period.
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  Thirty -seven people initially participated and
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  four withdrew. from the added program group.
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  One withdrew during training because of persistent
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  knee pain. Participants were screened for health
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  conditions that could make the training or supplements
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  unsuitable. The study gives us information about
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  this particular program and group of adults.
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  It does leave questions about who benefits most
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  and whether additional strength produces advantages
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  later. The added program included nutritional
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  support as well as weight training. Because the
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  researchers tested them together, we can't tell
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  how much each contributed to the results. The
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  study doesn't establish that you need the same
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  supplements or amounts. If you have a nutrition
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  concern, your doctor or a registered dietitian
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  can assess what fits your food intake and medical
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  needs. For more education and resources about
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  knee replacement, you can join the free Total
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  Knee Success Insider Newsletter. The sign -up
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  information is in the show notes. So, how does
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  this compare with earlier research? In a 2018
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  study by Husby and colleagues, 41 adults were
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  assigned by chance to maximal strength training
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  or standard rehabilitation. People doing the
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  heavier strength work gained more leg strength,
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  and the difference persisted at 12 months. At
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  12 months, the groups walked similar distances
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  during a six -minute test. A larger 2017 study
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  by Bade and colleagues compared higher - and
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  lower -intensity rehabilitation in 162 adults
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  starting soon after surgery. Both groups improved,
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  and the higher -intensity program didn't establish
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  an advantage in the main strength, walking, and
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  stair -climbing results at 3 or 12 months. A
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  2021 review brought together seven trials comparing
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  rehabilitation with and without progressive resistance
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  training, where the challenge increases as someone
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  gets stronger. The combined results favored that
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  training for knee muscle strength. The advantage
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  on the six -minute walking test was less certain.
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  It depended in part on including a study that
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  began training before surgery. When that study
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  was removed, the remaining results didn't establish
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  an extra walking benefit. Across those trials,
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  the extra benefit for strength was more consistent
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  than the extra benefit for walking distance.
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  So how can you use this information? Start with
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  a specific movement you want to improve. Suppose
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  you can push more weight at the gym but walking
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  to your seat at a ball game still takes more
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  effort than you'd like. Your strength work may
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  be helping while the longer walk also needs practice
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  at an appropriate pace and distance. Your therapist
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  can help you identify whether endurance, your
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  walking pattern, pain or another limitation is
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  affecting that outing. Increasing the leg press
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  weight alone may leave that part of your goal
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  untrained. The American Physical Therapy Association's
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  2026 guideline brings together research to help
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  physical therapists plan care after knee replacement.
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  It recommends progressive resistance training
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  along with walking, balance, and other movement
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  training. That supports keeping strength work
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  in your program while also practicing the movements
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  you want to improve. For a difficult chair transfer,
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  for example, your therapist may combine strengthening
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  with practice getting up from a suitable chair
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  height. There isn't one ideal combination for
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  everybody. To see whether that combination is
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  helping, notice a familiar task under reasonably
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  similar conditions. The same walk, the same chair,
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  the same short flight of stairs. Has it become
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  easier, or can you do it with better control
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  or less help? Your therapist can use strength
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  and movement tests to decide what to change next.
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  If a familiar strengthening movement has become
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  easy, it may be time to review its challenge.
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  A therapist can adjust the resistance, the movement,
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  or the amount of work to fit your current abilities.
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  If increasing the challenge brings repeated swelling,
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  worsening pain, or a decline in how you move,
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  have the program reviewed rather than continuing
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  to increase it. A calendar date or a weight used
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  in a study cannot determine the right progression
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  for an individual person like you. For a closer
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  look at the factors that influence your steps,
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  my book Walking Like Yourself Again After Knee
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  Replacement explains strength, knee movement,
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  balance, and walking habits in everyday language.
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  It's an educational resource to use alongside
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  your individual care, and you can find the book
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  through the link in the episode notes. Choose
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  one everyday movement you want to improve and
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  bring that goal to your next program review.
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  Your therapist can help connect what you're practicing
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  with a way to measure your progress. And always
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  remember, this episode provides general education
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  and does not replace individualized medical advice,
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  or establish a provider -patient relationship.
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  Follow your surgeon's and physical therapist's
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  guidance for your circumstances. In episode 22,
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  we'll look at research on which types of exercise
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  before knee replacement may help afterward. Thanks
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  for listening. I'm Michelle, and this has been
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  the Total Knee Success Podcast. This podcast
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  is for educational purposes only. Discover more
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  at TotalKneeSuccess .com. And be sure to subscribe
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  and share, because every step forward takes you
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  closer to living the life you love.