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Comparative effects of 12-week resistance training on unstable and stable surfaces on muscle stiffness, muscle co-activation, and balance in older patients with knee osteoarthritis.

Ping Liu·Mohamad Shariff A Hamid·Yueyue Shi·Xiaohan Fan·Hengzhi Deng·Eliza Hafiz·Xuelin Zhang·Yaru Hao
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Abstract

OBJECTIVE: This randomized trial compared the effects of unstable resistance training (URT), involving resistance exercises on unstable surfaces, and stable resistance training (SRT), performed on stable surfaces, on muscle stiffness, co-activation, and balance in older adults with knee osteoarthritis (KOA). We hypothesized that URT would yield greater improvements by enhancing neuromuscular adaptability. METHODS: Fifty patients with KOA were randomly assigned to the URT group (n&#x202f;=&#x202f;25) or the SRT group (n&#x202f;=&#x202f;25). After attrition, 46 participants (URT: n&#x202f;=&#x202f;23; SRT: n&#x202f;=&#x202f;23) completed the intervention and were included in the final analysis. Both groups completed a 12-week supervised lower-limb resistance training program (3 sessions/week) consisting of 10 exercises performed under either unstable or stable support conditions. RESULTS: After 12 weeks of intervention, both groups showed significant reductions in pain intensity (p&#x202f;<&#x202f;0.001). However, compared with the SRT group, the URT group demonstrated significantly greater reductions in quadriceps stiffness (p&#x202f;<&#x202f;0.05), selected hamstring stiffness outcomes (p&#x202f;<&#x202f;0.05), and quadriceps-hamstring co-activation (p&#x202f;<&#x202f;0.001), alongside superior improvements in both dynamic balance and static balance (all p&#x202f;<&#x202f;0.05). CONCLUSION: While both training modalities are effective for pain relief, URT elicited greater improvements in balance-related performance and neuromuscular-mechanical outcomes than SRT in older adults with KOA. These findings suggest that incorporating unstable support conditions into resistance training may provide additional rehabilitation benefits for this population.

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HumansResistance TrainingFemaleOsteoarthritis, KneeMalePostural BalanceAgedQuadriceps MuscleMiddle AgedTreatment OutcomePain MeasurementHamstring MusclesMuscle, SkeletalMuscle StrengthKnee osteoarthritisNeuromuscular adaptabilityStable resistance trainingUnstable resistance trainingJournal ArticleRandomized Controlled TrialComparative Study

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Ping Liu, Mohamad Shariff A Hamid, Yueyue Shi, Xiaohan Fan, Hengzhi Deng, Eliza Hafiz, Xuelin Zhang, Yaru Hao. 2026-07-21. Comparative effects of 12-week resistance training on unstable and stable surfaces on muscle stiffness, muscle co-activation, and balance in older patients with knee osteoarthritis.. https://doi.org/10.1016/j.gaitpost.2026.110287

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Journal Article; Randomized Controlled Trial; Comparative Study resourceAged subjectComparative Study subjectFemale subjectHamstring Muscles subjectHumans subjectJournal Article subjectMale subjectMiddle Aged subjectMuscle Strength subjectMuscle, Skeletal subjectPain Measurement subjectPostural Balance subjectRandomized controlled trials study

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