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High vs Low Intensity Strength Training for Knee Osteoarthritis

4 min read. Posted in Knee
Written by Physio Network info

A recent study aimed to compare the effect of high versus low intensity strength training in those with knee osteoarthritis.

We reviewed this study in the latest issue of our Research Reviews – where industry experts break down the most recent and clinically relevant studies, for immediate application in the clinic.

What you’ll read below is a snippet from the review.

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Back to the study!


STUDY TITLE: Effect of high-intensity strength training on knee pain and knee joint compressive forces among adults with knee osteoarthritis: the START randomized clinical trial – Messier et al (2021)

Study reviewed by Todd Hargrove in the April 2021 issue of the Research Reviews


Key points from the study

  • High-intensity strength training for knee osteoarthritis (OA) was not superior to low intensity training or general health workshop attendance.
  • Several different interventions may be effective for knee OA, and they should be chosen based on the specific needs and interests of the client.


Background and Objective

Knee osteoarthritis (OA) is a leading cause of disability. Prior research has shown that resistance training is effective at reducing pain, however questions remain about what level of intensity for resistance training is optimal.

This study sought to determine whether high-intensity strength training reduced knee pain and knee joint compressive forces better than low-intensity strength training and general health workshop attendance.



The study included 377 adults with mild to moderate knee osteoarthritis. Participants were all older than 50, and had not done strength training in the last six months. Participants were randomized into three treatment groups: high-intensity training, low-intensity training, and regular attendance at a general health workshop (attention control group).

Both the high-intensity and low-intensity groups did 3 sessions per week for 18 months. Each group did 6 lower body exercises. The high-intensity group progressed from 3 sets of 8 repetitions at 75% of 1RM, to 3 sets of 6 repetitions at 90% of 1RM. The low-intensity group performed 3 sets of 15 repetitions at 30% to 40% 1RM. The ‘attention control’ group attended a group workshop on general health twice a week for 6 months, and then once a week for 12 months.

The two primary outcomes were self-reported knee pain and maximum knee joint compressive force during walking.



  • There was no significant difference in knee pain or knee compressive forces during walking between the three groups at 18 months.
  • The large majority of secondary outcomes also showed no significant differences between the three groups.



  • The attention control group reduced pain by 33%! This may explain why there was no significant difference between the three groups.
  • The participants were generally white, male, and obese; therefore the results may not be generalizable to other patient demographics.


Clinical Implications

Prior research on knee OA has shown that strength training reduces pain, enhances well-being, and may increase shock absorption capability during walking. What hadn’t been well studied however, before this RCT, was whether high-intensity strength training could provide more pain relief than low-intensity training.

This study shows that both high and low-intensity strength training can be effective for those with knee OA. This supports the view that a key ingredient in the treatment of musculoskeletal pain is often not the exact details of the intervention, but rather the patient’s commitment to a plan of action that involves support from caregivers.


Here’s what this review looks like in our April issue.


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Here are the 11 other studies we’ve reviewed in our April issue just published:

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  • Preventing Bone Stress Injuries in Runners
  • Impact of Diastasis Recti Abdominis on Pain and Function
  • Cervical Spinal Nerve Mechanics During Neurodynamic Testing

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If you have a question, suggestion or a link to some related research, share below!

  • Naples Spine and Disc


    Nice blog and thank you for sharing it.

    Naples Spine and Disc | 08 April 2021 | Likes

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