Impact of Resistance Exercise and Nitrate Supplementation on Muscle Function and Clinical Outcomes After Knee Osteoarthritis Surgery in Middle-Aged Women with Sarcopenia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Bibliographic record
Abstract
Background/Objectives: Sarcopenia, characterized by reduced muscle mass and strength, is associated with osteoarthritis (OA), particularly in middle-aged women, and may worsen postoperatively. Resistance exercise (RE) can resolve sarcopenia; however, recovery is often suboptimal. Nitrate (NO3−) supplementation may enhance muscle recovery and complement RE. We investigated whether NO3− supplementation combined with RE improves thigh muscle mass and strength in middle-aged women during postoperative rehabilitation. Methods: We conducted a prospective randomized placebo-controlled double-blind study including 36 middle-aged women with sarcopenia and cartilage defects undergoing mesenchymal stem cell implantation. Participants were assigned to RE with NO3− supplementation (NG, n = 18) or with placebo (PG, n = 18) groups. Both groups underwent 12 weeks of supervised RE. The primary outcomes were thigh muscle cross-sectional area (CSA) and knee strength, whereas functional and clinical measures, including the Short Physical Performance Battery (SPPB), skeletal muscle index (SMI), International Knee Documentation Committee (IKDC), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, were secondary outcomes. Results: Thigh muscle CSA decreased in the PG but was maintained in the NG. Knee extension strength improved significantly in the NG compared with that in the PG at 6 and 12 weeks. Knee flexion strength also improved rapidly in the NG, with a significant increase at 6 weeks. SPPB and IKDC scores improved significantly in the NG. However, similar improvements were observed for WOMAC scores in both groups. Conclusions: NO3− supplementation combined with RE effectively prevented muscle atrophy and enhanced muscle strength in our study participants, indicating potential for improving postoperative recovery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".