{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:20:08Z","timestamp":1782973208195,"version":"3.54.5"},"reference-count":42,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100010843","name":"Foundation for Physical Medicine and Rehabilitation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010843","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR000001"],"award-info":[{"award-number":["UL1TR000001"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Knee osteoarthritis (OA) is a leading cause of disability that is associated with quadriceps weakness. However, strengthening in people with or with risk factors for knee OA can be poorly tolerated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the efficacy of a 12\u2010week low\u2010load exercise program, using a hybrid training system (HTS) that uses the combination of neuromuscular electrical stimulation and volitional contractions, for improving thigh muscle strength, knee pain relief, and physical performance in women with or with risk factors for knee OA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Randomized, single\u2010blinded, controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Exercise training laboratory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Forty\u2010two women 44\u201085 years old with risk factors for knee OA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Participants randomized to 12 weeks of biweekly low\u2010load resistance training with the HTS or on an isokinetic dynamometer (control).<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Maximum isokinetic knee extensor torque. Secondary measures included maximum isokinetic knee flexor torque, knee pain (Knee Injury and Osteoarthritis Outcome Score), and timed 20\u2010m walk and chair stand tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The HTS and control treatments resulted in muscle strengthening, decreased knee pain, and improved physical performance. HTS group quadriceps and hamstring strength increased by 0.06 \u00b1 0.04 Nm\/kg (<jats:italic>P<\/jats:italic> &gt; .05) and 0.05 \u00b1 0.02 Nm\/kg (<jats:italic>P<\/jats:italic> = .02), respectively. Control group quadriceps and hamstring strength increased by 0.03 \u00b1 0.04 Nm\/kg (<jats:italic>P<\/jats:italic> &gt; .05) and 0.06 \u00b1 0.02 Nm\/kg (<jats:italic>P<\/jats:italic> = .009), respectively. Knee pain decreased by 11.9 \u00b1 11.5 points (<jats:italic>P<\/jats:italic> &lt; .001) for the HTS group and 14.1 \u00b1 15.4 points (<jats:italic>P<\/jats:italic> = .001) for the control group. The 20\u2010m walk time decreased by 1.60 \u00b1 2.04 seconds (<jats:italic>P<\/jats:italic> = .005) and 0.95 \u00b1 1.2 seconds (<jats:italic>P<\/jats:italic> = .004), and chair stand time decreased by 4.8 \u00b1 10.0 seconds (<jats:italic>P<\/jats:italic> &gt; .05) and 1.9 \u00b1 4.7 seconds (<jats:italic>P<\/jats:italic> &gt; .05) in the HTS and control groups, respectively. These results did not differ statistically between the HTS and control groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These results suggest the HTS is effective for alleviating pain and improving physical performance in women with risk factors for knee OA. However, the HTS does not appear to be superior to low\u2010load resistance training for improving muscle strength, pain relief, or physical function.<\/jats:p><jats:p>Clinical trial registration number: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"ctgov:NCT02802878\">NCT02802878<\/jats:ext-link>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>I<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2018.05.014","type":"journal-article","created":{"date-parts":[[2018,5,29]],"date-time":"2018-05-29T03:32:22Z","timestamp":1527564742000},"page":"1301-1310","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Evaluation of the Combined Application of Neuromuscular Electrical Stimulation and Volitional Contractions on Thigh Muscle Strength, Knee Pain, and Physical Performance in Women at Risk for Knee Osteoarthritis: A Randomized Controlled 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