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Fitness & Exercise for Senior Citizens
Exercise Eliminated as Cause of Knee Osteoarthritis
in Older People
 Can be done safely without concerns
they
will develop OA
January 31, 2007 Senior citizens who have ducked
exercise because, they say, they fear developing osteoarthritis in their
knees seem to have lost this excuse. A long-term study of older people
has found that exercise does not increase the risk of OA in the knee,
although obesity does.
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Senior Citizen Fitness & Exercise |
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Regular exercise is strongly recommended for senior
citizens and baby boomers, but the effect of exercise on the development
of osteoarthritis (OA) in older people has been unclear, especially if
they are overweight. A new study published in the February 2007 issue of
Arthritis Care & Research examines the effects of physical activity over
a long period in older adults, many of whom were overweight, and found
that exercise neither protects against nor increases the risk of knee
OA.
Although, obesity has previously been identified as
a major risk factor for knee OA, this study looked at whether
weight-bearing activity, like walking, jogging, fitness training - may
be also harmful to people who are overweight.
Led by David T. Felson of the Boston University
School of Medicine in Boston, MA, researchers conducted a study of 1,279
subjects from the Framingham Offspring cohort, which consists of the
offspring of the original Framingham cohort. Persons were questioned
about recent physical activity they had engaged in on a regular basis,
and between one and two years later (1993-1994) had knee X-rays.
They were also asked questions about knee symptoms
such as pain, aching or stiffness. Between 2002 and 2005 they were
called back for a follow-up exam, during which they underwent the same
knee X-rays and were asked the same questions about symptoms, but not
about physical activity. They were also weighed initially and at
follow-up, when X-rays were read by a bone and joint radiologist and a
rheumatologist.
Analysis of the results showed no relationship
between recreational walking, jogging or other self-reported activity
and the development of knee OA. Even though the overweight patients had
an increased risk of developing OA, physical activity did not contribute
to this risk. Also, despite previous studies that suggested that
exercise may prevent joint space loss, the study did not find this to be
the case.
"This suggests that in middle-aged and older adults
who do not have OA, exercise does not protect against disease
development," the authors state.
The study attempted to examine all the ways in
which OA might appear by looking at X-rays that indicated the
development of structural disease using a well-known index (the Kellgren
and Lawrence scale), by looking at joint space loss, which is thought to
indicate cartilage loss, and also by examining symptoms.
The authors conclude: "Physical activity can be
done safely without concerns that persons will develop OA as a
consequence."
Review of 37 studies confirms study
In another study in the same issue, researchers led
by J.N. Belo of Erasmus Medical Center in Rotterdam, Netherlands
published an overview of 37 studies appearing up to December 2003 to
determine predictive factors of the progression of knee OA.
As was the case with the Felson study, they found
three studies showing no strong evidence that regular exercise was
related to progression of knee OA;
Other studies found that sex, knee pain, quadriceps
strength and knee injury were also not associated with progression of
knee OA. On the other hand, the presence of generalized OA and the level
of hyaluronic acid (a protein found in joints) were predictive of
progression of the disease.
Editorial: Exercise eliminated as cause
In an accompanying editorial in the current issue
Marian A. Minor of the University of Missouri in Columbia, MO notes that
the Felson study helps to clarify the understanding of the relationship
between knee OA and physical activity by using precise definitions of
OA, using valid methods to assess prior physical activity, and
evaluating the true incidence of the disease by eliminating patients who
showed evidence of it on X-rays taken when the study began.
"Taken together, these methods result in a useful
and valid study that supports recommending regular moderate physical
activity without undue fear that such activity may increase the risk for
knee OA," the author states. Since physical activity does not appear to
increase the risk of knee OA, the author wonders what variables may
possibly play a role in its development and progression.
She suggests that many studies fail to collect data
about knee OA, such as age at onset, occupational and medical history,
and response to medication and physical therapy, that may shed some
light on the disease.
Noting that future research should identify
variables relevant to knee OA that make a difference in individual
response, the author concludes: "In addition to improving the usefulness
of knee OA research, our ultimate aim must be to produce evidence that
assists clinical decision-making and individualized recommendations
regarding safety and effectiveness of interventions, including physical
activity."
>>
Arthritis Care & Research
Editor's Notes:
Article: "Effect of Recreational Physical
Activities on the Development of Knee Osteoarthritis in Older Adults of
Different Weights: The Framingham Study," David T. Felson, Jingbo Niu,
Margaret Clancy, Burton Sack, Piran Aliabadi, Yuqing Zhang, Arthritis
Care & Research, February 2007; (DOI: 10.1002/art.22464).
Article: "Prognostic Factors of Progression of
Osteoarthritis of the Knee: A Systematic Review of Observational
Studies," J.N. Belo, M.Y. Berger, M. Reijman, B.W. Koes, S.M.A.
Bierma-Zeinstra, Arthritis Care & Research, February 2007; (DOI:
10.1002/art.22475).
Editorial: "Physical Activity and Knee
Osteoarthritis: Answers and Questions," Marian A. Minor, Arthritis Care
& Research, February 2007; (DOI: 10.1002/art.22485).
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