Therapeutic and physical fitness exercise prescription for older adults with joint disease: an evidence-based approach

Acute resistance exercise combined with whole body vibration and blood flow restriction: Molecular and neurocognitive effects in late-middle-aged and older adults

Limited research exists regarding the effects of resistance exercise (RE) combined with whole body vibration (WBV), blood flow restriction (BFR), or both on the neuropsychological performance of working memory (WM) in late-middle-aged and older adults and regarding the physiological mechanisms underlying this effect. This study thus explored the acute molecular and neurophysiological mechanisms underlying WM performance following RE combined with WBV, BFR, or both. Sixty-six participants were randomly assigned into a WBV, BFR, or WBV + BFR group. Before and after the participants engaged in a single bout of isometric RE combined with WBV, BFR, or both, this study gathered data on several neurocognitive measures of WM performance, namely, accuracy rate (AR), reaction time (RT), and brain event-related potential (specifically P3 latency and amplitude), and data on biochemical indices, such as the levels of insulin-like growth factor-1 (IGF-1), norepinephrine (NE), and brain-derived neurotrophic factor (BDNF). Although none of the RE modalities significantly affected RTs and P3 latencies, ARs and P3 amplitudes significantly improved in the WBV and WBV + BFR groups. The WBV + BFR group exhibited greater improvements than the WBV group did. Following acute RE combined with WBV, BFR, or both, IGF-1 and NE levels significantly increased in all groups, whereas BDNF levels did not change. Crucially, only the changes in NE levels were significantly correlated with improvements in ARs in the WBV + BFR and WBV groups. The findings suggest that combining acute RE with WBV, BFR, or both could distinctively mitigate neurocognitive decline in late-middle-aged and older adults.

The elderly's satisfaction with physical activity programs in senior welfare centers

Introduction

Healthcare for the aging population has become a crucial issue in South Korea to maintain the elderly's quality of life, and physical activity is of primary importance for older adults. This study evaluated the exercise characteristics and satisfaction of the elderly who participated in physical activity programs provided by senior welfare centers in South Korea.

Methods

We surveyed 266 participants to learn the characteristics of the elderly's exercise participation and their satisfaction with instructors, exercise programs, and facilities provided by senior welfare centers. A total of 263 copies were analyzed using the SPSS 23.0 statistical software.

Results and discussion

The top three physical activity programs that the elderly participated in senior welfare centers were dancing (25.3%), gymnastics (24.8%), and table tennis/badminton (13.2%). There were significant differences in respondents' satisfaction according to sex, education level, spouse, family type, and monthly income per household (p < 0.05). The elderly were satisfied with programs (4.183 ± 0.483), facilities (3.881 ± 0.483), and instructors (3.604 ± 0.483) in order. Also, this study shows that user satisfaction differs depending on the demographic characteristics (gender, education, marital status, family type, economic status) and the characteristics of the exercise participation of the elderly (exercise duration, participation period).

Conclusions

In conclusion, we presented the elderly's satisfaction with physical activity programs in senior welfare centers, suggesting that the elderly need physical activity programs according to their demographic and exercise characteristics.

Daily Walking and the Risk of Knee Replacement Over 5 Years Among Adults With Advanced Knee Osteoarthritis in the United States

OBJECTIVE

To examine the association of the volume and intensity of daily walking at baseline with the risk of knee replacement (KR) over 5 years in adults with advanced structural knee osteoarthritis.

DESIGN

Prospective, longitudinal, and multicenter observational study.

SETTING

Osteoarthritis Initiative study with follow-up from 2008-2015.

PARTICIPANTS

Community-dwelling adults with or at risk of knee osteoarthritis were recruited from 4 sites in the United States (N=516; mean age, 67.7±8.6y; body mass index, 29.3±4.7 kg/m2; 52% female). We included participants with advanced structural disease, without KR and had valid daily walking data (quantified using Actigraph GT1M), at baseline.

INTERVENTIONS

Not applicable.

MAIN OUTCOMES

KR. Walking volume was measured as steps/day and intensity as minutes/day spent not walking (0 steps/min) and walking at very light (1-49 steps/min), light (50-100 steps/min), or moderate (>100 steps/min) intensities. To examine the relationship of walking volume and intensity with the risk of KR, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for covariates.

RESULTS

Of 516 adults with advanced structural disease, 88 received a KR over 5 years (17%). Walking an additional 1000 steps/d was not associated with the risk of KR (adjusted HR=0.95; 95% CI, 0.84-1.04). Statistically, replacing 10 min/d of very light and light walking with 10 min/d of moderate walking reduced the risk of KR incidence by 35% and 37%, respectively (adjusted HR=0.65, 95% CI, 0.45-0.94, for very light and adjusted HR=0.63; 95% CI, 0.40-1.00, for light).

CONCLUSIONS

Daily walking volume and intensity did not increase KR risk over 5 years and may be protective in some cases in adults with advanced structural knee osteoarthritis.

Exercise programs for the management of people with hand osteoarthritis: a scoping review protocol

REVIEW QUESTIONS

The review questions for this scoping review are.

Minimum Performance on Clinical Tests of Physical Function to Predict Walking 6,000 Steps/Day in Knee Osteoarthritis: An Observational Study

OBJECTIVE

Evidence of physical function difficulties, such as difficulty rising from a chair, may limit daily walking for people with knee osteoarthritis (OA). The purpose of this study was to identify minimum performance thresholds on clinical tests of physical function predictive to walking ≥6,000 steps/day. This benchmark is known to discriminate people with knee OA who develop functional limitation over time from those who do not.

METHODS

Using data from the Osteoarthritis Initiative, we quantified daily walking as average steps/day from an accelerometer (Actigraph GT1M) worn for ≥10 hours/day over 1 week. Physical function was quantified using 3 performance-based clinical tests: 5 times sit-to-stand test, walking speed (tested over 20 meters), and 400-meter walk test. To identify minimum performance thresholds for daily walking, we calculated physical function values corresponding to high specificity (80-95%) to predict walking ≥6,000 steps/day.

RESULTS

Among 1,925 participants (mean ± SD age 65.1 ± 9.1 years, mean ± SD body mass index 28.4 ± 4.8 kg/m² , and 55% female) with valid accelerometer data, 54.9% walked ≥6,000 steps/day. High specificity thresholds of physical function for walking ≥6,000 steps/day ranged 11.4-14.0 seconds on the 5 times sit-to-stand test, 1.13-1.26 meters/second for walking speed, or 315-349 seconds on the 400-meter walk test.

CONCLUSION

Not meeting these minimum performance thresholds on clinical tests of physical function may indicate inadequate physical ability to walk ≥6,000 steps/day for people with knee OA. Rehabilitation may be indicated to address underlying impairments limiting physical function.

Effects of a tailor-made exercise program on exercise adherence and health outcomes in patients with knee osteoarthritis: a mixed-methods pilot study

Introduction

Previous studies showed that exercise intervention was effective in symptoms control of knee osteoarthritis (OA) but poor intervention adherence reduced the exercise effect. It has been suspected that the design of exercise intervention mainly from the health care professionals’ perspective could not address the patients’ barriers to exercise. Therefore, a tailor-made exercise program which incorporated the patient’s perspective in the design was developed and ready for evaluation.

Objectives

This pilot study estimated the effects of a tailor-made exercise program on exercise adherence and health outcomes, and explored the participants’ perception and experience of the program.

Methods

The intervention of this study was a 4-week community-based group exercise program, which required the participants to attend a 1-hour session each week. Thirty-four older people with knee OA were recruited to the program. Mixed-methods study design was used to estimate the effects of this program and explore the participants’ perception and experience of the program. Exercise adherence and performance in return-demonstration of the exercise were assessed at 12 weeks after the program. Disease-specific health status (Western Ontario and McMaster Universities Osteoarthritis Index), general health status (12-item Short Form of the Medical Outcome Study Questionnaire), knee range of motion, muscle strength, and endurance of the lower extremities (Timed-Stands Test) were measured at the beginning of the program and 12 weeks after. Six participants were interviewed individually on the 12th week.

Results

Thirty-three participants (75.0±7.3 years) completed the one-group pretest and post-test study. The participants’ exercise adherence was 91.4%±14.54%, and their correct performance in return-demonstration was 76.7%±21.75%. Most of the participants’ health outcomes significantly improved at posttests except the 12-item Short Form of the Medical Outcome Study Questionnaire physical health summary score. The qualitative findings provided rich information to explain and support the quantitative results.

Conclusion

The results of this study showed that a tailor-made exercise program could improve exercise adherence and health outcomes in older people with knee OA.

Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases

Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products, and their integration with self-care, music and mHealth, expands precision/personalized medicine strategies for chronic diseases via pharmacological-behavioral combination therapies.

The relationship between physical aspects of quality of life and extreme levels of regular physical activity in adults

This study aimed to check for any significant differences in perceived quality of life, specifically aspects of a physical nature, among volunteers who are more physically active and those less physically active in a university community. The sample consisted of 1,966 volunteers in a university community in Brazil. To assess physical activity levels, volunteers responded to the International Physical Activity Questionnaire (IPAQ), and to analyse the perception of quality of life they responded to WHOQOL-bref, which is classified into three groups according to level of physical activity, taking into account the metabolic equivalent index (MET) over a full week. For comparison, consideration was given to the first and third tertiles, respectively, namely groups of more and less active students. The results indicated that individuals who engaged in more physical activity had a more positive perception of quality of life compared to those who were less active in physical aspects related to the ability to work, energy for day-to-day activities and locomotion.

Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension

OBJECTIVE

To investigate the effectiveness of an exercise intervention for decreasing fatigue severity and increasing physical activity in individuals with pulmonary arterial hypertension (PAH). A small, phase 2 randomized clinical trial of the effect of aerobic exercise training on fatigue severity and physical activity in patients with idiopathic or PAH associated with other conditions was conducted.

METHODS

Twenty-four patients with PAH (24 female; age: 54.4 ± 10.4 years; BMI: 30.8 ± 7.2 kg/m(2)) participated in the study. A convenience sample was recruited in which 9% (28 of 303) of screened patients were enrolled. The project was carried out in a clinical pulmonary rehabilitation clinic during existing pulmonary rehabilitation program sessions. Patients with PH were randomized into a 10-week program that consisted of patient education only or patient education plus an aerobic exercise-training regimen. Both groups received 20 lectures, two per week over the 10-weeks, on topics related to PAH and its management. The aerobic exercise training consisted of 24-30 sessions of treadmill walking for 30-45 min per session at an intensity of 70-80% of heart rate reserve, three days per week over the 10 weeks.

RESULTS

After 10-weeks of intervention, patients receiving aerobic exercise training plus education reported routinely engaging in higher levels of physical activity (p < 0.05) and a decrease in fatigue severity (p = 0.03). Patients in the education only group did not report changes in fatigue severity or participation in physical activity.

CONCLUSIONS

The 10-week aerobic exercise training intervention resulted in increased physical activity and decreased fatigue in individuals with PAH. ClinicalTrials.gov Identifier: NCT00678821.

Effects of physiotherapy treatment on knee osteoarthritis gait data using principal component analysis

BACKGROUND

Interpreting gait data is challenging due to intersubject variability observed in the gait pattern of both normal and pathological populations. The objective of this study was to investigate the impact of using principal component analysis for grouping knee osteoarthritis (OA) patients' gait data in more homogeneous groups when studying the effect of a physiotherapy treatment.

METHODS

Three-dimensional (3D) knee kinematic and kinetic data were recorded during the gait of 29 participants diagnosed with knee OA before and after they received 12 weeks of physiotherapy treatment. Principal component analysis was applied to extract groups of knee flexion/extension, adduction/abduction and internal/external rotation angle and moment data. The treatment's effect on parameters of interest was assessed using paired t-tests performed before and after grouping the knee kinematic data.

FINDINGS

Increased quadriceps and hamstring strength was observed following treatment (P<0.05). Except for the knee flexion/extension angle, two different groups (G(1) and G(2)) were extracted from the angle and moment data. When pre- and post-treatment analyses were performed considering the groups, participants exhibiting a G(2) knee moment pattern demonstrated a greater first peak flexion moment, lower adduction moment impulse and smaller rotation angle range post-treatment (P<0.05). When pre- and post-treatment comparisons were performed without grouping, the data showed no treatment effect.

INTERPRETATION

The results of the present study suggest that the effect of physiotherapy on gait mechanics of knee osteoarthritis patients may be masked or underestimated if kinematic data are not separated into more homogeneous groups when performing pre- and post-treatment comparisons.

Psychological interventions for rheumatoid arthritis: examining the role of self-regulation with a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To examine the efficacy of psychological interventions for rheumatoid arthritis (RA), and to determine whether self-regulation interventions demonstrate efficacy superior to that of other psychological treatments.

METHODS

Only randomized controlled trials testing a face-to-face psychological intervention among patients with RA were included. Two independent investigators extracted pertinent study data, rated each study on a scale of methodologic quality, and assessed each treatment condition for its inclusion of 5 behavior-change techniques derived from self-regulation theory (goal setting, planning, self-monitoring, feedback, and relapse prevention).

RESULTS

Twenty-seven trials were included, and cumulative effect sizes were calculated for the 5 outcomes. Significant effect sizes (Hedges' g) were found at posttreatment for physical activity (0.45), pain (0.18), disability (0.32), depressive symptoms (0.23), and anxiety (0.17). At followup (range 2-14 months), significant effect sizes were obtained for physical activity (0.36), pain (0.13), disability (0.15), and depressive symptoms (0.32). Comparative analyses revealed that interventions utilizing more self-regulation techniques reduced depressive symptoms and anxiety significantly more than interventions utilizing fewer such techniques. Additionally, depressive symptoms were reduced significantly more among recently diagnosed RA patients than among those with longstanding RA.

CONCLUSION

Psychological interventions are beneficial for many patients with RA, particularly when it comes to increasing physical activity levels. Intervention techniques derived from self-regulation theory appear to play a role in reducing depressive symptoms and anxiety among patients with RA.

Limited joint mobility (LJM) in elderly subjects with type II diabetes mellitus

LJM is frequently observed in young subjects with insulin-dependent diabetes mellitus (IDDM). Aim of this study was to evaluate whether non-insulin-dependent diabetes mellitus (NIDDM) increases the risk of LJM in elderly subjects. Thirty patients (15 males, 15 females, mean age 73.93 ± 12.72 years) with NIDDM in good glycemic control were compared with thirty non-diabetic elderly, well matched for sex and age (15 males, 15 females, mean age 74.3 ± 4.24 years), and with ten young normal subjects (5 males, 5 females, mean age 26.3 ± 1.56 years). In these subjects, the range of motion (ROM) of ankle, knee, hip, elbow and shoulder were measured with a double-armed goniometer. Moreover, abnormalities of supraspinatus, patellar and Achilles tendons were evaluated with a standardized ultrasound (US) procedure. A significant reduction in the mobility of all joints was found in elderly subjects, compared to younger ones, with exception for the knee and elbow flexion. Elderly patients with diabetes, compared with their age-matched counterpart, showed LJM for ankle dorso- and plantar flexion, hip flexion and adduction, shoulder abduction and flexion. Moreover, tendons sonographic abnormalities were more frequently observed in diabetics. Our data confirm that diabetes worsens the LJM in the elderly, increasing the cross-linking of collagen by the non-enzymatic advanced glycation end products formation.

Características da marcha de um paciente com osteoartrose de quadril com e sem auxílio de bengala

O objetivo deste estudo foi comparar características espaciais, temporais e espaço-temporais da marcha de um paciente com osteoartrose de quadril com e sem o auxílio de dispositivo (bengala). O caso é o de um sujeito com osteoartrose de quadril esquerdo de 63 anos, 97,8 kg e 1,76 m. Um sistema de reconstrução tridimensional de movimento foi utilizado para análise da marcha. Foram registrados três ciclos completos da marcha com e sem a utilização da bengala, sendo analisadas variáveis espaciais, temporais e espaço-temporais. Foi feita análise estatística, com nível de significância de 5%. Os principais resultados indicam que o comprimento de passo direito (CPD) e esquerdo (CPE), bem como o comprimento total do ciclo, foram superiores com o uso da bengala durante a marcha; o CPE foi significativamente maior do que o CPD quando o sujeito utilizava a bengala; todas as variáveis temporais foram estatisticamente menores com o uso da bengala; a cadência da marcha e a velocidade foram estatisticamente superiores com a bengala. Pode-se concluir que o uso da bengala gerou diferenças significativas no comportamento das variáveis espaciais, temporais e espaço-temporais durante a marcha, melhorando de forma significativa a eficiência do movimento do paciente com osteoatrose de quadril.

The responsiveness of three-dimensional knee accelerations used as an estimation of knee instability and loading transmission during gait in osteoarthritis patient's follow-up

OBJECTIVE

Knee instability and joint loading transmission are two important biomechanical factors in subjects with knee osteoarthritis (OA). However, the relationship between these factors in a rehabilitation treatment remains unclear. The purpose of this study is to determine the responsiveness of a new three-dimensional (3D) acceleration method used as an estimation of knee instability and joint loading transmission during gait in OA subjects after a rehabilitation treatment.

METHOD

Twenty-four subjects with medial knee OA were included in this study. They had clinical and gait evaluations before and after 12 weeks of treatment. 3D linear knee accelerations, quadriceps and hamstring isometric strength and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) pain were quantified, and compared between both evaluations. Nine asymptomatic subjects participated in this study for gait comparison.

RESULTS

A significant reduction of the anterior posterior (AP) knee acceleration peak (P=0.02) had been detected after the treatment. No difference for both distal and lateral knee accelerations peak was found. A significant increase in quadriceps (P<0.001) and hamstring (P=0.006) strength was seen after treatment. The WOMAC of pain had shown significant reduction after the treatment (P<0.001).

CONCLUSION

The present study demonstrates that the estimation of knee acceleration parameters is sensitive to changes in knee OA gait after a rehabilitation treatment. This study also indicates that a treatment of 3 months which combines therapeutic and exercises program could have benefits on knee OA by increasing AP knee stability and stabilize joint loading transmission during gait.

Physical activity levels in patients with early knee osteoarthritis measured by accelerometry

OBJECTIVE

Physical activity (PA) is recommended for osteoarthritis (OA) management to reduce pain and improve function. The purpose of this study was to objectively assess the level and pattern of PA in male and female knee OA patients to determine adherence to Centers for Disease Control and Prevention/American College of Sports Medicine and Exercise and Physical Activity Conference recommendations for PA.

METHODS

Early OA patients (n = 255, 76% women, mean +/- SD age 54.6 +/- 7.1 years, mean +/- SD body mass index 27.8 +/- 4.3 kg/m(2)) with Kellgren/Lawrence-defined grade II (no higher) radiographic OA in at least 1 knee wore an accelerometer for 6-7 contiguous days. Light (LPA), moderate (MPA), and vigorous (VPA) PA intensities were defined as accelerometer recordings of 100-2,224, 2,225-5,950, and >5,950 counts per minute, respectively.

RESULTS

Patients wore accelerometers for a mean +/- SD of 6.8 +/- 0.3 days and 13.8 +/- 2.2 hours/day, and spent much more time (P < 0.001) in MPA (23.6 +/- 17.2 minutes/day) than VPA (0.95 +/- 3.5 minutes/day). Men spent significantly (P < 0.05) more time in all PA intensities than women. Only 30% of patients achieved recommended PA levels. The proportion of men (47%) achieving the recommendation was significantly (P = 0.04) higher than women (24%).

CONCLUSION

Knee OA patients accumulate little VPA and most (70%) do not achieve recommended levels for MPA or greater. New strategies to increase levels of PA in this population are needed.

Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review

This systematic review investigates the effectiveness of exercise interventions in improving disease-related characteristics in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes suitable for improving the cardiovascular profile of RA patients and proposes areas for future research in the field. Six databases (Medline, Cochrane Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify publications from 1974 to December 2006 regarding RA and exercise interventions. The quality of the studies included was determined by using the Jadad scale. Initial searches identified 1342 articles from which 40 met the inclusion criteria. No studies were found investigating exercise interventions in relation to cardiovascular disease in RA. There is strong evidence suggesting that exercise from low to high intensity of various modes is effective in improving disease-related characteristics and functional ability in RA patients. Future studies are required to investigate the effects of exercise in improving the cardiovascular status of this patient population.

Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee

AIM

This paper reports a study of the effects of aquatic exercise on physical fitness (flexibility, strength and aerobic fitness), self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee.

BACKGROUND

Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement. Exercise is important for preventing and/or managing the functional limitations associated with joint disease. Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis; however, few studies have examined the effects on people with osteoarthritis, and these have yielded inconsistent results.

METHODS

A two-group randomized controlled trial with a convenience sample was used. Participants were recruited from community sources and randomly assigned to a 12-week aquatic programme or a non-exercise control condition. Data for 38 participants were collected at baseline, week 6, and week 12 during 2003 and 2004. Instruments were a standard plastic goniometer, a handheld dynamometer, the 6-minute walk test, the multidimensional Health Assessment Questionnaire, and a visual analogue scale for pain.

RESULTS

Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility, strength and aerobic fitness, but had no effect on self-reported physical functioning and pain. The exercise adherence rate was 81.7%, and no exercise-related adverse effect was observed or reported.

CONCLUSIONS

Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee. Although the programme may not offer pain relief or self-reported improvements in physical functioning, results suggest that aquatic exercise does not worsen the joint condition or result in injury. Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients.

Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty

OBJECTIVE

To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty.

METHODS

A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to a 6-week exercise or education (control) intervention immediately prior to surgery. We assessed outcomes through questionnaires and performance measures. Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery.

RESULTS

Among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score (improvement of 2.2 in exercisers versus decline of 3.9 in controls; P = 0.02) and Short Form 36 physical function score (decline of 0.4 in exercisers versus decline of 14.3 in controls; P = 0.003). No significant differences were seen in TKA patients. Exercise participation increased muscle strength preoperatively (18% in THA patients and 20% in TKA patients), whereas the control patients had essentially no change in strength (P > 0.05 for exercise versus education in both THA and TKA groups). Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients (adjusted odds ratio 0.27, 95% confidence interval 0.074-0.998). The intervention had no effects on outcomes 8 and 26 weeks postoperatively.

CONCLUSION

A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA. Additionally, exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation.

Associations of changes in exercise level with subsequent disability among seniors: a 16-year longitudinal study

BACKGROUND

The effect of changes in physical exercise on progression of musculoskeletal disability in seniors has rarely been studied.

METHODS

We studied a prospective cohort annually from 1984 to 2000 using the Health Assessment Questionnaire Disability Index (HAQ-DI). The cohort included 549 participants, 73% men, with average end-of-study age of 74 years. At baseline and at the end of the study, participants were classified as "High" or "Low" vigorous exercisers using a cut-point of 60 min/wk. Four groups were formed: "Sedentary" (Low-->Low; N = 71), "Exercise Increasers" (Low-->High; N = 27), "Exercise Decreasers" (High-->Low; N = 73), and "Exercisers" (High-->High; N = 378). The primary dependent variable was change in HAQ-DI score (scored 0-3) from 1984 to 2000. Multivariate statistical adjustments using analysis of covariance included age, gender, and changes in three risk factors, body mass index, smoking status, and number of comorbid conditions. Participants also prospectively provided reasons for exercise changes.

RESULTS

At baseline, Sedentary and Increasers averaged little exercise (16 and 22 exercise min/wk), whereas Exercisers and Decreasers averaged over 10 times more (285 and 212 exercise min/wk; p <.001). All groups had low initial HAQ-DI scores, ranging from 0.03 to 0.08. Increasers and Exercisers achieved the smallest increments in HAQ-DI score (0.17 and 0.11) over 16 years, whereas Decreasers and Sedentary fared more poorly (increments 0.27 and 0.37). Changes in HAQ-DI score for Increasers compared to Sedentary were significantly more favorable (p <.05) even after multivariate statistical adjustment.

CONCLUSIONS

Inactive participants who increased exercise achieved excellent end-of-study values with increments in disability similar to those participants who were more active throughout. These results suggest a beneficial effect of exercise, even when begun later in life, on postponement of disability.

Chronic osteoarthritis and adherence to exercise: a review of the literature

Osteoarthritis (OA) is a chronic disease that disables many aging adults. People with OA are often asked to adhere to prescribed exercise regimens that must be undertaken in the presence of pain and other disease-related symptoms. We conducted a review of literature that focused on what is known about exercise adherence and the factors that influence exercise adherence among people with OA. Results revealed multiple determinants of exercise adherence; however, these determinants have not been carefully studied in the context of exercise adherence and OA. Almost all studies of exercise adherence among people with OA are short-term and do not use validated measures of adherence. Moreover, poor adherence is the most compelling explanation for the declining impact of the benefits of exercise over time. We conclude that interventions to enhance self-efficacy, social support, and skills in long-term monitoring of progress are necessary to foster exercise adherence among people with OA.

Managing noncardiac pain in heart failure patients

Both acute and chronic pain are common coexisting problems in patients with heart failure. Because nonsteroidal anti-inflammatory drugs and corticosteroids are contraindicated in heart failure, traditional pain management algorithms require modification. This article reviews pertinent pain management principles, including pain vocabulary, barriers to pain management, and general pain assessment and treatment measures. Issues unique to the heart failure patient are discussed and specific interventions for the heart failure patient with acute or chronic pain are then delineated.

Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up

OBJECTIVE

To investigate at 5 years whether an initial 2 year home based strength training period imposes sustained effects on muscle strength, bone mineral density (BMD), structural joint damage, and on disease activity in patients with early rheumatoid arthritis (RA).

METHODS

Seventy patients were randomised either to perform home based strength training with loads of 50-70% of repetition maximum (EG) or range of motion exercises (CG). Both groups were encouraged to take part in aerobic activities 2-3 times a week. Maximal muscle strength of different muscle groups was measured by dynamometers, and BMD at the femoral neck and lumbar spine by dual x ray densitometry. Disease activity was assessed by the 28 joint disease activity score, and joint damage by x ray findings.

RESULTS

62 patients completed 2 years' training and 59 patients attended check up at 5 years. Mean (SD) maximum muscle strength indices increased from baseline to 2 years-in EG from 212 (78) kg by a mean (95% CI) of 68 (55 to 80) and in CG from 195 (72) kg by 35 (13 to 60) kg-and remained at that level for the next 3 years. Development of BMD in EG tended to be more favourable than that in CG. Muscle strength training was not detrimental to joint structures or disease activity.

CONCLUSION

The patients' exercise induced muscle strength gains during a 2 year training period were maintained throughout a subsequent self monitored training period of 3 years. Despite substantial training effects in muscle strength, BMD values remained relatively constant. Radiographic damage remained low even at 5 years.

Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders1∗1No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.∗Key references

This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions for arthritides, fractures, cardiovascular disorders, peripheral vascular disease, amputations, pulmonary disorders, cancer, stroke, traumatic brain injury, Parkinson's disease, spinal cord injury, peripheral neuropathies, and diabetic complications.

OVERALL ARTICLE OBJECTIVE

To summarize the physical medicine and rehabilitation interventions for commonly disabling conditions of older adults.

A home-based two-year strength training period in early rheumatoid arthritis led to good long-term compliance: a five-year followup

OBJECTIVE

To evaluate the impact of a 2-year home-based strength-training program on physical function in patients with early rheumatoid arthritis (RA) after a subsequent 3-year followup.

METHODS

Seventy patients with early RA were randomized to perform either strength training (experimental group [EG]) or range-of-motion exercises (control group [CG]). Maximal strength values were recorded by dynamometers. The Modified Disease Activity Score (DAS28), pain, Health Assessment Questionnaire (HAQ), walking speed, and stair-climbing speed were also measured.

RESULTS

The maximum strength of assessed muscle groups increased by 19-59% in the EG during the training period and remained at the reached level throughout the subsequent 3 years. Muscle strength improved in the CG by 1-31%, but less compared with the EG. During the 2-year training period, DAS28 decreased by 50% and 45% and pain by 67% and 39% in the EG and CG, respectively. The differences in muscle strength, DAS28, and HAQ were significantly in favor of the EG both at the 2-year and 5-year followup assessments.

CONCLUSIONS

The improvements achieved during the 2-year strength-training period were sustained for 3 years in patients with early RA.

Evaluating the complex chronic pain patient

The evaluation of the complex chronic pain patient should be different than for the patient with a simple pain problem. The former requires a team approach. It is important that the neurosurgeon contemplating a pain-relieving operation get the best information that is likely to have an impact on outcome. This should include the following: 1. Some way to extract the appropriate information contained in the patient's medical records. 2. Physical factors that have a negative impact on prognosis. 3. Psychologic information, including return-to-work decisions, medication use issues, meaning of prior successes, negative environmental factors, codependency issues, secondary gains and their impact, presence of pain games, negatively acting financial considerations, impact of depression, presence of poor role models, impact of pain on general functioning, and the patient's future plans. Consider that just like a successful operation is a symphony of relatively simple harmonious parts, so, too, is the assessment of the complex chronic pain patient. The complexity of the patient and her or his predicament should not impair your ability to understand her or his real needs. The appropriate assessment of the patient requires that issues other than the pain itself be factored into the decisions about interventions. In the end, it is not appropriate to suggest afterward that psychosocial factors were the major cause for a poor result when nothing had been done about the same factors that had been present before the procedure.

An obligation for primary care physicians to prescribe physical activity to sedentary patients to reduce the risk of chronic health conditions

Physical inactivity increases the risk of many chronic disorders. Numerous studies have convincingly demonstrated that undertaking and maintaining moderate levels of physical activity (eg, brisk walking 3 hours a week) greatly reduces the incidence of developing many chronic health conditions, most notably type 2 diabetes mellitus, obesity, cardiovascular disease, and many types of cancers. However, the underlying mechanistic details of how physical activity confers such protective effects are not well understood and consequently constitute an active area of research. Although changing an individual's ingrained behavior is commonly perceived to be difficult, encouraging evidence suggests that intensive and repeated counseling by health care professionals can cause patients to become more physically active. Therefore, counseling patients to undertake physical activity to prevent chronic health conditions becomes a primary prevention modality. This article summarizes the vast epidemiologic and biochemical evidence supporting the many beneficial health implications of undertaking moderate physical activity and provides a rationale for incorporating physical activity counseling as part of routine practice in the primary care setting.

Exercise in the treatment of osteoarthritis

Few medical professionals would dispute the obvious health benefits afforded by regular exercise if pursued judiciously and in moderation. Cardiovascular disease, hypertension, osteoporosis, diabetes, depression, and fibromyalgia are a few of the many disorders in which exercise plays a key role in management. Less well-appreciated until recently is the beneficial effect exercise may have in the treatment of osteoarthritis (OA). Previously, rest and inactivity seemed to be the prevailing treatment strategy until it was recognized that this approach was ineffective and contributed further to the patient's disability and loss of function. New trial data support the value of physical exercise whether it involves aerobic or resistance-type training. The studies are not without statistical and methodologic imperfections. Still, the evidence favoring an exercise intervention as part of the OA treatment plan is impressive. It remains for the clinician to select an appropriate exercise routine that meets the strength, balance, flexibility, and aerobic needs of the patient. The clinician then monitors and evaluates the patient's response to this activity with the same exactness used in following pharmacologic therapy.