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Globally recognized rehabilitation guidelines for knee OA include patient education and neuromuscular exercises (NEMEX). While heavy\u2010load resistance exercise (70%\u201390% 1RM) often induces pain with knee OA, low\u2010load exercise (20%\u201340% 1RM) combined with partial blood\u2010flow restriction (BFR\u2010RE) has been introduced without inducing excessive knee joint pain. The present study aimed to compare the effects of NEMEX and BFR\u2010RE on mechanical muscle function in knee OA individuals. Ninety\u2010six participants (age 56.7\u2009\u00b1\u20097.6; 47 males, 49 females) with symptomatic, radiographic knee OA were randomized to free\u2010flow land\u2010based NEMEX or unilateral machine\u2010based BFR\u2010RE. Both groups exercised biweekly for 12\u2009weeks while also receiving patient education. Outcomes measured from baseline to 12\u2009weeks included maximal isometric knee extensor strength (MVIC), rate of force development (RFD), maximal leg extensor power (LEP), and cross\u2010sectional area (mCSA) of rectus femoris (RF) and vastus lateralis (VL). Significant (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) within\u2010group improvements from baseline to 12\u2009weeks were observed in both groups for MVIC (BFR\u2010RE: +0.4 vs. NEMEX: +0.1\u2009Nm\/kg), LEP (+0.6 vs. +0.2\u2009W\/kg), mCSA for RF (+1.8 vs. +0.6\u2009cm<jats:sup>2<\/jats:sup>), and VL (+3.7 vs. +1.0\u2009cm<jats:sup>2<\/jats:sup>). BFR\u2010RE led to increases in RFD (+2.11 (50\u2010ms), +4.48 (200\u2010ms) Nm\/s\/kg) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), whereas NEMEX did not (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Between\u2010group comparisons revealed greater improvements with BFR\u2010RE for all outcomes (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). BFR\u2010RE appears superior to NEMEX in enhancing mechanical muscle function and knee extensor mCSA in knee OA individuals. The enhanced physiological responses observed with BFR\u2010RE suggest that this exercise modality should be considered as an adjunct therapeutic tool in future treatment protocols for knee OA patients.<\/jats:p>","DOI":"10.1111\/sms.70069","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T04:33:40Z","timestamp":1747370020000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of Blood\u2010Flow Restricted Resistance Exercise Versus Neuromuscular Exercise on Mechanical Muscle Function in Adults With Chronic Knee Osteoarthritis\u2014A Secondary Analysis From a Randomized Controlled Trial"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3322-6044","authenticated-orcid":false,"given":"Brian","family":"S\u00f8rensen","sequence":"first","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark  Odense M Denmark"},{"name":"Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen (ISMC) Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Physical &amp; Occupational Therapy Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4308-5484","authenticated-orcid":false,"given":"S. Peter","family":"Magnusson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen (ISMC) Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Physical &amp; Occupational Therapy Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene B.","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen (ISMC) Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Health Technology, Center for Fast Ultrasound Imaging Technical University of Denmark  Lyngby Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9389-9152","authenticated-orcid":false,"given":"Mikkel H.","family":"Hjortshoej","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen (ISMC) Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Physical &amp; Occupational Therapy Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Centre for Health and Rehabilitation University College Absalon  Slagelse Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie K.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Geriatric Research Unit, Department of Geriatric and Palliative Medicine Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Suetta","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"},{"name":"Geriatric Research Unit, Department of Geriatric and Palliative Medicine Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Coupp\u00e9","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen (ISMC) Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Physical &amp; Occupational Therapy Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn E.","family":"Johannsen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen (ISMC) Copenhagen University Hospital Bispebjerg\u2010Frederiksberg  Copenhagen NV Denmark"},{"name":"Fures\u00f8\u2010Reumatologerne Rheumatology Clinic  Farum Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Aagaard","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark  Odense M Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00163-7"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar2655"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-1940"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20140360"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-022-05635-9"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kex515"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3467"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2019.06.011"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1439-y"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2020.12.024"},{"issue":"12","key":"e_1_2_10_12_1","first-page":"A4554","article-title":"Group Education and Exercise Is Feasible in Knee and Hip Osteoarthritis","volume":"59","author":"Skou S. 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