title: Changes in voluntary quadriceps activation predict changes in quadriceps strength after therapeutic exercise in patients with knee osteoarthritis.
abstract: BACKGROUND
  Recent rehabilitation paradigms have suggested that improving voluntary muscle activation may optimize strength outcomes related to resistance training. The aim of this study was to determine if changes in voluntary quadriceps activation could predict changes in quadriceps strength following a 4 week therapeutic exercise regimen.
  
  
  METHODS
  Thirty-six participants with tibiofemoral osteoarthritis volunteered for this study, while 30 participants (14 males, 16 females, 58 ± 11.8 years, 172.2 ± 9.2 cm, 87.1 ± 18.5 kg) finished the 4 week supervised therapeutic exercise protocol and were used in the final analysis. Demographics, quadriceps strength and voluntary quadriceps activation using the burst superimposition technique were evaluated prior to the intervention. Following the therapeutic exercise program, quadriceps strength and voluntary activation were assessed. Simple correlations were performed to determine covariates in a multiple regression equation to evaluate if changes in voluntary quadriceps activation could predict changes in quadriceps strength.
  
  
  RESULTS
  There was a significant moderate simple correlation between participant height and change in MVIC (r=-0.44, P=0.01). Both height and changes in voluntary quadriceps activation significantly predicted changes in MVIC (R(2)=0.66, P<0.001). After controlling for patient height, a change in voluntary quadriceps activation produced a significant improvement in the prediction of a change in MVIC (ΔR(2)=0.47, P<0.001).
  
  
  CONCLUSIONS
  Changes in voluntary quadriceps activation predicted 47% of variance in the change in quadriceps strength. These results suggest that interventions aimed at manipulating quadriceps activation may be helpful for improving quadriceps strength in patients with tibiofemoral osteoarthritis.
authors.affiliation: Department of Kinesiology, University of Toledo, Toledo, OH, USA. brian.pietrosimone@utoledo.edu
authors.forename: Brian G
authors.initials: BG
authors.lastname: Pietrosimone
authors.forename: Susan A
authors.initials: SA
authors.lastname: Saliba
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000628:therapy*; D011237:Predictive Value of Tests; D052097:Quadriceps Muscle / Q000503:physiopathology*; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome