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ObjectiveKnee osteoarthritis (KOA) is a leading cause of global disability and remains challenging to treat. Blood flow restriction (BFR) shows promising rehabilitation outcomes, but its lasting effects in KOA are lacking. This study aimed to determine the 1-year outcomes of a BFR-enhanced exercise therapy programme in patients with KOA.MethodsThis study included 120 patients (33 male, 87 female) from a previously published randomised controlled trial comparing 12 weeks of traditional exercise therapy with and without BFR, performed twice per week. For the current analysis, patients were reassessed at 1 year. The primary outcome was the Knee Osteoarthritis Outcome Score (KOOS) questionnaire, with secondary outcomes including muscle strength and a functional test battery. Data on knee joint injections and activity levels were also reviewed at 1-year follow-up. Analyses consisted of linear mixed models with Dunn-Sidak corrections for multiple comparisons, with an intention to treat approach (NCT04996680).ResultsClinically meaningful improvements at 1 year were found in favour of the BFR group for KOOS subscales ‘pain’ (mean difference (MD): 15.1 points ES=0.79, p=0.0039), ‘symptoms’ (MD: 10.5 points, ES=0.51, p=0.0074), ‘activities of daily living’ (ADL) (MD: 11.3 points, ES=0.54, p=0.0054) and ‘quality of life’ (QoL) (MD: 14.7 points, ES=0.61, p=0.0032) compared with exercise therapy without BFR. The BFR group outperformed the non-BFR group for the functional tests, and muscle strength remained significantly higher at 1 year in the BFR group (ES=0.48, p=0.0010) as opposed to no BFR. The BFR group was more active by 1.5 hours/week (p=0.036) and had 3.6 times lower odds of receiving knee injections compared with the non-BFR group.ConclusionA 12-week BFR-enhanced exercise therapy programme provides benefits for pain, symptoms, ADL, QoL, muscle strength and functional capacity at 1-year follow-up while reducing the need for knee injections by 63.4% compared with traditional exercise therapy alone.

Knee osteoarthritis is a prevalent joint disease affecting millions of individuals globally. While total knee arthroplasty is an effective treatment for advanced stages of KOA, it may not be suitable for earlier stages or younger patients. Supervised exercise therapy has proven to be the first-line treatment of preference in tackling pain and disability caused by KOA. However, the high intensities required to induce positive muscle adaptations are not indicated in this population, as this is often accompanied by pain, discomfort, and frustration, leaving low-load resistance training as the only feasible method of treatment. Recently, the use of blood flow restriction training has begun to emerge as a substitute for high-load resistance training. With BFRT, a cuff is applied around the proximal aspect of the affected limb, causing partial arterial and full venous occlusion, thereby inducing localized hypoxia and the accumulation of metabolites, mimicking the effects of high-load resistance training, albeit with low loads. Consequently, BFRT might offer a suitable and more effective alternative for KOA patients who are not (yet) eligible for TKA compared to traditional exercise therapy. This review aims to summarize the current evidence as regards the application of Blood Flow Restriction in exercise therapy for knee osteoarthritis patients, with particular consideration of the underlying mechanisms and its safety, as well as general guidelines for practical implementation in clinical practice. In doing so, this narrative review aims to create a framework for translating from theory into practice.

BackgroundRoad cycling is one of the most popular endurance sports worlwide. Due to its cyclic character, the prolonged flexion posture and significant training volumes, it is associated with a high overuse injury prevalence. To prevent these injuries, control of cycling posture is thought to be imperative. To what extent cycling posture relates with susceptibility to injury, has not been investigated so far.ObjectiveThis study wanted to assess how cycling posture and kinematics vary in function of exercise intensity, and how this relates to the prevalence of overuse injuries.DesignCross-sectional observational study (three-dimensional (3D) kinematic analysis).SettingComprehensive kinematic analysis of trunk and lower limb during cycling task of increasing intensity.Patients (or Participants)67 recreational road cyclists.Interventions (or Assessment of Risk Factors)Participants were submitted to an exertional cycling protocol, using their own race bike on a stationairy ergometer system. Throughout the test, 3D kinematic data of lower limb and trunk were captured at constant time-intervals. Afterwards, data on power, heart rate, power-related kinematic changes and the presence of cycling-specific complaints were submitted to statistical analysis.Main Outcome MeasurementsPower-increment-related kinematic changes and their association with overuse injuries.ResultsResults revealed that kinematic patterns changed significantly in function of power output (p<0,024). More so, frontal plane control of trunk and pelvis during down stroke were significantly associated with injury prevalence (p<0.042). This kinematic variability presented no direct association with the slope of the heart rate curve nor maximal power output.ConclusionsCycling kinematics differ significantly in function of power and the presence of physical complaints, irrespective of performance capacity. This might have repercussions on comfort, performance and injury susceptibility in cycling. Besides a carefully customized bike-fit, control in the trunk and pelvis are suggested to be essential to optimize comfort and reduce injury risk.

ObjectiveTo examine the effects of autoregulated (AUTO) and non-autoregulated (NAUTO) blood flow restriction (BFR) application on adverse effects, performance, cardiovascular and perceptual responses during resistance exercise.MethodsFifty-six healthy participants underwent AUTO and NAUTO BFR resistance exercise in a randomised crossover design using a training session with fixed amount of repetitions and a training session until volitional failure. Cardiovascular parameters, rate of perceived effort (RPE), rate of perceived discomfort (RPD) and number of repetitions were investigated after training, while the presence of delayed onset muscle soreness (DOMS) was verified 24 hours post-session. Adverse events during or following training were also monitored.ResultsAUTO outperformed NAUTO in the failure protocol (p<0.001), while AUTO scored significantly lower for DOMS 24 hours after exercise (p<0.001). Perceptions of effort and discomfort were significantly higher in NAUTO compared with AUTO in both fixed (RPE: p=0.014, RPD: p<0.001) and failure protocol (RPE: p=0.028, RPD: p<0.001). Sixteen adverse events (7.14%) were recorded, with a sevenfold incidence in the fixed protocol for NAUTO compared with AUTO (NAUTO: n=7 vs AUTO: n=1) and five (NAUTO) vs three (AUTO) adverse events in the failure protocol. No significant differences in cardiovascular parameters were found comparing both pressure applications.ConclusionAutoregulation appears to enhance safety and performance in both fixed and failure BFR-training protocols. AUTO BFR training did not seem to affect cardiovascular stress differently, but was associated with lower DOMS, perceived effort and discomfort compared with NAUTO.Trial registration number NCT04996680.

ObjectivesKnee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes.MethodsThe Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach (NCT04996680).ResultsThe BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups.ConclusionIncorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period.Trial registration numberNCT04996680.

Purpose In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA. Methods Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component. Results A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants ( p  = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°). Conclusion This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated. Level of evidence IV.

Key Points Traditional vascular risk factors are more common in young patients with stroke—especially those over 35 years of age—than was previously thought; thus, 'young' stroke increasingly resembles 'old' stroke Long-term secondary prevention after stroke seems as important in young adults as in older individuals, although trials are needed to establish which patients will benefit from different treatment strategies Poor functional outcome and psychosocial problems are common among young patients (under 50 years of age) with stroke The long-term prevalence of psychosocial consequences, and their influence on daily life, must be further investigated, so as to optimize specific rehabilitation programmes for young patients with stroke The average age of ischaemic stroke onset is decreasing, owing to a rise in the incidence of stroke among individuals under 50 years of age. In this article, the authors review the current literature on risk factors for and aetiology of 'young' ischaemic stroke. In addition, they discuss the lifelong implications of stroke in young adults, not only in terms of cardiovascular disease recurrence, but also with respect to psychosocial consequences, including cognitive and social impairments, mood disorders and fatigue. Contrary to trends in most other diseases, the average age of ischaemic stroke onset is decreasing, owing to a rise in the incidence of stroke among 'young' individuals (under 50 years of age). This Review provides a critical overview of the risk factors and aetiology of young ischaemic stroke and addresses its long-term prognosis, including cardiovascular risk, functional outcome and psychosocial consequences. We highlight the diminishing role of 'rare' risk factors in the pathophysiology of young stroke in light of the rising prevalence of 'traditional' vascular risk factors in younger age groups. Long-term prognosis is of particular interest to young patients, because of their long life expectancy and major responsibilities during a demanding phase of life. The prognosis of young stroke is not as favourable as previously thought, with respect either to mortality or cardiovascular disease or to psychosocial consequences. Therefore, secondary stroke prevention is probably a life-long endeavour in most young stroke survivors. Due to under-representation of young patients in past trials, new randomized trials focusing on this age group are needed to confirm the benefits of long-term secondary preventive medication. The high prevalence of poor functional outcome and psychosocial problems warrants further study to optimize treatment and rehabilitation for these young patients.

Dietary polyphenols are components of many foods such as tea, fruit, and vegetables and are associated with several beneficial health effects although, sofar, largely based on epidemiological studies. The intact forms of complex dietary polyphenols have limited bioavailability, with low circulating levels in plasma. A major part of the polyphenols persists in the colon, where the resident microbiota produce metabolites that can undergo further metabolism upon entering systemic circulation. Unraveling the complex metabolic fate of polyphenols in this human superorganism requires joint deployment of in vitro and humanized mouse models and human intervention trials. Within these systems, the variation in diversity and functionality of the colonic microbiota can increasingly be captured by rapidly developing microbiomics and metabolomics technologies. Furthermore, metabolomics is coming to grips with the large biological variation superimposed on relatively subtle effects of dietary interventions. In particular when metabolomics is deployed in conjunction with a longitudinal study design, quantitative nutrikinetic signatures can be obtained. These signatures can be used to define nutritional phenotypes with different kinetic characteristics for the bioconversion capacity for polyphenols. Bottom-up as well as top-down approaches need to be pursued to link gut microbial diversity to functionality in nutritional phenotypes and, ultimately, to bioactivity of polyphenols. This approach will pave the way for personalization of nutrition based on gut microbial functionality of individuals or populations.

IntroductionPost-stroke fatigue negatively influences short-term functional outcome in older stroke survivors. In young adults, in the midst of their active working and family life, this influence may even be more pronounced. However, there are only few studies on this topic in young patients with stroke. Therefore, we investigated the long-term prevalence of post-stroke fatigue in patients with a young transient ischaemic attack (TIA) or ischaemic stroke and its association with functional outcome.MethodsThis study is part of a large cohort study among 511 stroke survivors with a first-ever TIA or ischaemic stroke, aged 18–50 years. After a mean follow-up of 9.8 (SD 8.4) years, we assessed the presence of fatigue with the fatigue subscale of the Checklist Individual Strength questionnaire and functional outcome. Prevalence of fatigue between young patients with stroke and 147 stroke-free sex-matched and age-matched controls was compared. OR's for poor functional outcome on modified Rankin Score (mRS>2) and Instrumental Activities of Daily Living (IADL<8) and cognitive performance were calculated using logistic regression analysis.ResultsOf the young patients with stroke, 41% experienced symptoms of fatigue, versus 18.4% in controls (p 0.0005). Fatigue was associated with a poor functional outcome, as assessed by the mRS (OR 4.0 (95% CI 1.6 to 9.6), IADL (OR 2.2 (95% CI 1.1 to 4.6), and impairment in speed of information processing (OR 2.2 (95% CI 1.3 to 3.9).ConclusionsFatigue was very common in young stroke survivors and was associated with a poor functional outcome, even after almost a decade of follow-up.