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Correlation Between Muscle Strength and Functional Improvement After a Neuromuscular Electrical Strengthening Associated with Undenatured Type II Collagen in Knee Osteoarthritis

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Abstract

Knee osteoarthritis (OA) is one of the most common musculoskeletal disorders, affecting 2693 out of every 100,000 women and 1770 out of every 100,000 men. The main treatment for OA is education and exercise. Aerobic and strengthening exercises are effective in reducing pain and disability. Moreover, the nutraceutical undenatured type II collagen (UC-II) has been studied in patients with knee OA. Knee muscle strength is shown to be related to physical function in people with knee OA. This study analyzed the correlation between muscle strength and function in patients with knee OA after a muscle strengthening exercise program and UC-II supplementation. A randomized, single-blinded, placebo-controlled trial of 100 patients with grade I to III knee OA. The groups were as follows: UC-II (CG), placebo UC-II (PCG), UC-II and NMES Strengthening (CNSG), placebo UC-II and NMES Strengthening (PCNSG), and NMES Strengthening (NSG), each with 20 participants. The following were evaluated: knee quadriceps muscle strength, objective function (6MWT and TUG), and subjective function (WOMAC and Lequesne), at 30 days, 90 days, and 6 months after the intervention. The CG improved function only 6 months after the interventions (p < 0.05). The CNSG and PG improved quadriceps strength and function in all reevaluations (p < 0.05). There was a moderate to strong correlation between bilateral quadriceps strength and objective function as assessed by TUG and 6MWT at 30 days in the CNSG and PG (p < 0.005), this effect remaining after 6 months of intervention (p < 0.05). There was a moderate to strong correlation between bilateral quadriceps muscle strength and objective function as assessed by WOMAC and Lequesne scores in the CNSG and NSG at all times of the study (p < 0.05). Muscle strength gain was significantly correlated with objective and subjective functional improvement in patients with knee OA. The combination of muscle strengthening and UC-II administration potentiated this functional gain.

Trial registration

Brazilian Registry of Clinical Trials (REBEC): RBR-8ghcx3

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available because they are only saved in the statistical software used, but are available from the corresponding author upon reasonable request.

Abbreviations

OA:

Osteoarthritis

UC-II:

Native (undenatured) type II collagen

CG:

Collagen group

PCG:

Placebo collagen group

CNSG:

Collagen + NMES Strengthening group

PCNSG:

Placebo collagen + NMES Strengthening group

NSG:

NMES Strengthening group

TUG:

Timed Up & Go test

6MWT:

6-Minute Walk Test

TKA:

Total knee arthroplasty

BMI:

Body mass index

MVIC:

Maximal voluntary isometric contraction

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

NMES:

Neuromuscular electrical stimulation

SPSS:

Statistical Package for the Social Sciences

ANOVA:

Analysis of variance

NSAIDs:

Nonsteroidal anti-inflammatory drugs

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Acknowledgements

To the Group of Studies and Research in Sports Rehabilitation and Orthopedic Trauma (GEPRETO) of the Lutheran University of Brazil, Torres city, Rio Grande do Sul State, Brazil.

To the handling pharmacy Sealife® in Torres/RS, Brazil, represented by the pharmacist-in-charge Josele Milanez Paz for the preparation of UC-II and placebo UC-II capsules.

To the Physiotherapy Clinic Kinesiophysio Ltda® in Capão da Canoa/RS, Brazil, represented by its owners Raísa de Bem and Andressa Souza Machado, for the space provided for conducting evaluations.

To Dr. Paulo Afonso Kuplich, orthopedist and traumatologist, for conducting the preinterventional clinical and radiological evaluation.

Funding

The study was funded by the Infinity Pharma® Laboratory, although it did not participate neither in data collection and analysis nor in the writing of the final article.

Author information

Authors and Affiliations

  1. Torres, Brazil

    Ana Paula Costa, Verine Cunha Teixeira & Bruno da Silva Schwarstzhoupt

  2. Department of Physiotherapy, Lutheran University of Brazil, Torres, RS, Brazil

    Carlos Monteiro & Rodrigo Boff Daitx

  3. Capão da Canoa, Brazil

    Patrícia Mota Ferreira

  4. Department of Physiotherapy, Gurupi University (UNIRG), Rua Joaquim Batista de Oliveira, 355. Vila Alagoana, Gurupi, TO, Brazil

    Marcelo Baptista Dohnert

Authors
  1. Ana Paula Costa
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  2. Carlos Monteiro
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  3. Verine Cunha Teixeira
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  4. Bruno da Silva Schwarstzhoupt
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  5. Patrícia Mota Ferreira
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  6. Marcelo Baptista Dohnert
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  7. Rodrigo Boff Daitx
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Contributions

Authors APC and VC performed the blind evaluations. Authors MP and PCF were responsible for physiotherapy admissions and UC-II administration. The author MBD was responsible for analyzing the results. Authors MBD and RBD wrote the final version of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marcelo Baptista Dohnert.

Ethics declarations

Ethics Approval and Consent to Participate

The study was approved by the Ethics Committee on Research with Human Beings at the Lutheran University of Brazil, under Opinion number 1,426,470. Before entering the study, all participants signed an Informed Consent for their participation.

Consent for Publication

Not applicable.

Competing Interests

The authors declare that they have no competing interests.

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Costa, A.P., Monteiro, C., Teixeira, V.C. et al. Correlation Between Muscle Strength and Functional Improvement After a Neuromuscular Electrical Strengthening Associated with Undenatured Type II Collagen in Knee Osteoarthritis. SN Compr. Clin. Med. 3, 1122–1132 (2021). https://doi.org/10.1007/s42399-021-00830-6

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