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Fitness & Exercise for Senior Citizens
Osteoarthritis Pain Reduced Slightly by Exercising
in Warm Water
Almost all senior citizens afflicted by age 70 with
this chronic disease
Oct. 17, 2007 - For patients suffering from
osteoarthritis of the hip or knee – primarily senior citizens - doing
aerobic and stretching exercises in warm water can bring some relief
from the pain and could improve daily function, a new review of research has found.
“Osteoarthritis is a chronic disease of the joint
cartilage and bone, often thought to result from "wear and tear" on a
joint, although there are other causes such as congenital defects,
trauma and metabolic disorders. Joints appear larger, are stiff and
painful and usually feel worse the more they are used throughout the
day,” according to
MedlinePlus.
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Knee and hip osteoarthritis are widespread diseases
seen in up to 6 percent of the population. The main goal of treatment is
to improve pain control, according to a team of Danish reviewers, which
included Bente Danneskiold-Samsøe, professor at The Parker Institute in
Frederiksberg.
The aim of the systematic review was to determine
the effectiveness of one form of such treatment - aquatic exercise.
According to the Arthritis Foundation,
osteoarthritis is the oldest and most common form of arthritis and
affects an estimated 21 million Americans. This chronic condition causes
the breakdown of the joint’s cartilage, which then causes the bones to
rub against each other, leading to stiffness, pain and loss of movement
in the joint. The Cochrane reviewers write that osteoarthritis accounts
for “more trouble in walking and climbing stairs than any other
musculoskeletal disease.”
Treating osteoarthritis typically includes a
combination of medication, weight control, physical therapy and
exercise. In aquatic exercise, also known as “pool therapy” or
“hydrotherapy,” patients perform tasks, such as aerobic activities or
stretching and strengthening and range of motion exercises, in water
heated to about 90 to 97 degrees Fahrenheit.
The Cochrane reviewers analyzed six trials that had
800 participants who all were living with osteoarthritis. Four studies
included patients with osteoarthritis of either the knee or hip, one
study followed patients with only hip arthritis and one included
patients with only knee arthritis.
In the studies, some patients did aquatic exercises
for different lengths of time and numbers of sessions per week, while
other patients did no exercise or exercised on land. Most of the studies
measured patients after three months of therapy.
Based on the studies’ results, the reviewers said,
“In people with osteoarthritis of the hip or knee, pain may decrease by
1 more point on a scale of 0 to 20 with aquatic exercise, and function
may improve by 3 more points on a scale of 0 to 68.”
“There is gold-level evidence that for
osteoarthritis of the hip or knee, aquatic exercise probably slightly
reduces pain and slightly improves function over three months,” the
reviewers wrote. “Based on this, one may consider using aquatic exercise
as the first part of a longer exercise program for osteoarthritis
patients.”
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Why Your Knee Hurts |
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The location of knee pain can help identify the problem.
Pain on the
front of the knee can be due to bursitis, arthritis, or softening of the
patella cartilage as in chondromalacia patella.
Pain on the sides of the
knee is commonly related to injuries to the collateral ligaments,
arthritis, or tears to the meniscuses.
Pain in the back of the knee can
be caused by arthritis or cysts, known as Baker’s cysts. Baker’s cysts
are an accumulation of joint fluid (synovial fluid) that forms behind
the knee.
Overall knee pain can be due to bursitis, arthritis, tears in
the ligaments, osteoarthritis of the joint, or infection.
Instability, or giving way, is also another common knee problem.
Instability is usually associated with damage or problems with the
meniscuses, collateral ligaments, or patella tracking.
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The reviewers were unable to find evidence on
whether aquatic exercise affected patients’ walking ability or stiffness
after treatment sessions.
Wanda Evans, a physical therapy resource specialist
at Kaiser Permanente, said that her clinic uses aquatic therapy to treat
80 percent to 90 percent of patients with hip and knee osteoarthritis
and “100 percent” of them experience some improvement.
“Oftentimes, aquatics are the primary course of
treatment if the patient is obese and 80 percent of our patients with
this diagnosis are obese,” Evans said. “Otherwise, it is considered an
adjunct to the primary course of treatment, which is land-based
exercises.”
The reviewers concluded that more research could
help determine long-term effects and to understand which types of
aquatic exercise — as well as for how often and how long — might benefit
osteoarthritis sufferers.
Evans said in her experience, whether the
beneficial results of aquatic exercise are short- or long-term varies
among patients.
“Because this condition is a degenerative process,
no conservative treatment will ever give you complete long-term
results,” she said.
“However, aquatic exercise will absolutely prolong
the need for surgical intervention and, in some cases, can delay the
need for surgery for years.”
Editor’s Notes:
The review appears in the current issue of The
Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates research in all aspects of
health care. Systematic reviews draw evidence-based conclusions about
medical practice after considering both the content and quality of
existing trials on a topic.
The Cochrane Collaboration is an international
nonprofit, independent organization that produces and disseminates
systematic reviews of health care interventions and promotes the search
for evidence in the form of clinical trials and other studies of
interventions. Visit
http://www.cochrane.org for more information.
Bartels EM, et al. Aquatic exercise for the
treatment of knee and hip osteoarthritis (Review). Cochrane Database of
Systematic Reviews 2007, Issue 4.
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