Aşırı Kilolu ve Obez Kadınlarda Üç Farklı Diz Patolojisinde İzokinetik Kuvvetlendirmenin Fonksiyonel Sonuçlara Etkisi: Bütünleşik Bir Nöro-Fonksiyonel Rehabilitasyon Çerçevesi

Öz

İzokinetik kuvvetlendirme, diz patolojilerinin rehabilitasyonunda giderek daha değerli bir yöntem olarak kabul edilmektedir. Bu durum özellikle kas-iskelet sistemi bozuklukları ve fonksiyonel kısıtlılıklar açısından daha yüksek risk taşıyan aşırı kilolu ve obez kadınlar için önemlidir. Bu sentez, patellofemoral ağrı sendromu (PFAS), kronik menisküs lezyonları ve diz osteoartritinde izokinetik antrenmanın etkilerini değerlendiren üç prospektif klinik çalışmanın bulgularını bütünleştirmektedir. Katılımcılar, belirlenmiş klinik ve görüntüleme kriterlerine göre bu üç diz patolojisinden biri tanısı almış, 40–65 yaş aralığında, aşırı kilolu veya obez kadınlardan oluşmuştur (BKİ ≥25 kg/m²). Her çalışmada randomize kontrollü bir tasarım kullanılmış; müdahale gruplarına 6–8 hafta boyunca, patolojiye bağlı olarak konsantrik veya eksantrik şekilde uygulanan denetimli izokinetik kuvvetlendirme protokolleri verilmiş, kontrol grupları ise geleneksel rehabilitasyon programına alınmıştır. Birincil sonuç değişkenleri; kas kuvveti (izokinetik dinamometri ile), fonksiyonel performans (sandalyeden kalkma, otur-kalk, merdiven çıkma ve 10 metre yürüme testleri), ağrı (KOOS Ağrı alt ölçeği) ve yaşam kalitesi (KOOS Yaşam Kalitesi alt ölçeği) olarak belirlenmiş ve başlangıçta ile müdahale sonrasında değerlendirilmiştir. PFAS’da, konsantrik izokinetik antrenman quadriceps tepe torkunda %32’lik bir artışa yol açmış (1,07±0,36’dan 1,41±0,42 Nm/kg’a), sandalyeden kalkma performansını artırmış (10,1±1,4’ten 18,8±1,1 tekrara) ve KOOS Yaşam Kalitesi skorlarında iyileşme sağlamıştır (29,8±2,7’den 4,3±1,9’a). Kronik menisküs lezyonlarında, aktif izokinetik protokoller otur-kalk performansını artırmış (9,7±1,5’ten 19,1±1,7 tekrara), merdiven çıkma süresini azaltmış (7,3±1,2’den 5,1±1,0 saniyeye) ve KOOS Ağrı skorlarında iyileşme sağlamıştır (27,4±4,2’den 4,0±1,9’a). Diz osteoartritinde ise eksantrik izokinetik antrenmanın nöromüsküler elektrik stimülasyonu ile birlikte uygulanması, 10 metre yürüme süresini azaltmış (7,6±0,7’den 5,5±0,5 saniyeye), sandalyeden kalkma performansını artırmış (9,1±1,0’dan 19,3±1,5 tekrara) ve KOOS Yaşam Kalitesi skorlarını iyileştirmiştir (13,4±1,3’ten 2,9±1,4’e). Bu sonuçlar, tek başına veya yardımcı modalitelerle birlikte uygulanan izokinetik kuvvetlendirmenin, aşırı kilolu/obez kadınlarda farklı diz bozuklukları kapsamında kas fonksiyonu, mobilite, ağrı ve yaşam kalitesinde belirgin iyileşmeler sağladığını göstermektedir. Farklı patolojilerde elde edilen yararların tutarlılığı, bu risk grubuna yönelik multidisipliner rehabilitasyon stratejilerine izokinetik protokollerin entegre edilmesini desteklemektedir.

Anahtar Kelimeler

• İzokinetik kuvvetlendirme
• diz rehabilitasyonu
• obezite
• patellofemoral ağrı
• menisküs lezyonu
• osteoartrit

Isokinetic Strengthening Across Three Knee Pathologies in Overweight/Obese Women: A Neuro-Functional Rehabilitation Perspective

Öz

Isokinetic strengthening is increasingly recognized as a valuable modality in the rehabilitation of knee pathologies, particularly among overweight and obese women, a population at heightened risk for musculoskeletal disorders and functional limitations. This synthesis integrates findings from three prospective clinical studies evaluating the effects of isokinetic training on patellofemoral pain syndrome (PFPS), chronic meniscal lesions, and knee osteoarthritis. Participants were overweight or obese women (BMI ≥25 kg/m²), aged 40–65 years, diagnosed with one of the three knee pathologies according to established clinical and imaging criteria. Each study employed a randomized controlled design, with intervention groups receiving supervised isokinetic strengthening protocols (concentric or eccentric, depending on pathology) over 6 to 8 weeks, while control groups underwent conventional rehabilitation. Primary outcomes included muscle strength (isokinetic dynamometry), functional performance (chair stand, sit-to-stand, stair climb, 10-m walk), pain (KOOS Pain subscale), and quality of life (KOOS QoL subscale), assessed at baseline and post-intervention. In PFPS, concentric isokinetic training led to a 32% increase in quadriceps peak torque (1.07±0.36 to 1.41±0.42 Nm/kg), improved chair stand performance (10.1±1.4 to 18.8±1.1 reps), and enhanced KOOS QoL scores (29.8±2.7 to 4.3±1.9). For chronic meniscal lesions, active isokinetic protocols improved sit-to-stand (9.7±1.5 to 19.1±1.7 reps), stair climb time (7.3±1.2 to 5.1±1.0 s), and KOOS Pain scores (27.4±4.2 to 4.0±1.9). In knee osteoarthritis, combining eccentric isokinetic training with neuromuscular electrical stimulation reduced 10-m walk time (7.6±0.7 to 5.5±0.5 s), increased chair stand performance (9.1±1.0 to 19.3±1.5 reps), and improved KOOS QoL (13.4±1.3 to 2.9±1.4). These results demonstrate that isokinetic strengthening, alone or combined with adjunct modalities, yields substantial improvements in muscle function, mobility, pain, and quality of life across diverse knee disorders in overweight/obese women. The consistency of benefits across pathologies supports the integration of isokinetic protocols into multidisciplinary rehabilitation strategies for this at-risk population.

Anahtar Kelimeler

• Isokinetic strengthening
• knee rehabilitation
• obesity
• patellofemoral pain
• meniscal lesion
• osteoarthritis

Kaynakça

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