Effects of Adding End-Range Isometric Holds to Isotonic Knee Extensor Training on Isokinetic Performance in Sedentary Adults

Quadriceps femoris weakness is associated with several musculoskeletal conditions, including knee osteoarthritis, and is a common target of physiotherapy strengthening protocols. While isotonic and isokinetic strengthening methods have each been studied separately, it remains unclear whether adding an isometric hold to isotonic exercise provides additional benefit in isokinetic strength outcomes. This study addressed that question.

This was a randomized, two-arm study conducted at the Sportomed Sports Health and Orthopedic Rehabilitation Clinic (December 2014-May 2015). Forty-six sedentary, healthy adults aged 18-40 years were enrolled, with 43 completing the 8-week protocol. Exclusion criteria included lower-extremity musculoskeletal problems, prior lower-extremity surgery or significant trauma, low back pain, cardiac or neurological conditions, and chronic systemic disease. The study was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (decision no. 257, 07.11.2014), and written informed consent was obtained from all participants.

Participants were randomized to two groups. Both performed isotonic knee-extension exercise (2 sets × 10 repetitions, 60% of 1RM) 3 days/week for 8 weeks, with weekly load progression (~5%) and 60 seconds rest between sets. Group 1 (n=21) added a 5-second isometric hold at 0° knee extension at the end of each repetition; Group 2 (n=22) performed the isotonic protocol without this addition.

Outcomes were assessed at baseline and after 8 weeks: thigh circumference, 1RM isotonic quadriceps strength, and isokinetic peak torque (PT, Nm) at 60°/second and 180°/second using a CSMI Humac Norm 2004 dynamometer. Baseline assessments also included range of motion, manual muscle testing, and physical activity level (IPAQ Short Form).

Statistical analysis was performed using NCSS 2007. Normality was assessed with Shapiro-Wilk testing. Between-group comparisons used independent t-tests or Mann-Whitney U tests as appropriate; within-group pre-post comparisons used paired t-tests. Categorical variables were compared using chi-square testing, and correlations using Pearson testing. Significance was set at p<0.05.

Inclusion criteria

• Age 18-40 years
• Sedentary lifestyle (low physical activity level)
• Healthy individuals with no known knee-related disability

Exclusion criteria

• Musculoskeletal problems of the lower extremity
• History of lower extremity surgery or significant trauma
• Low back pain and/or lumbar region problems
• Cardiac complaints
• Neurological complaints
• Chronic systemic disease (e.g., diabetes mellitus, rheumatologic conditions)