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Database: MEDLINE <1966 to May Week 4 2002> Search Strategy: (Arthritis and exercise) -------------------------------------------------------------------------------- 1 exercise/ or exercise therapy/ (34161) 2 exp Arthritis/ (110796) 3 1 and 2 (804) 4 (*exercise/ or *exercise therapy/) and exp *Arthritis/ (306) 5 limit 4 to (human and english language) (235) 6 limit 5 to yr=1998-2002 (98) 7 limit 6 to review (21) 8 limit 6 to yr=2000-2002 (66) 9 (exercise and arthritis).ti. and 8 (12) 10 7 or 9 (29) 11 exp sports/ and 8 (15) 12 10 or 11 (41) 13 from 12 keep 1-41 (41) 14 from 13 keep 1-41 (41) *************************** <1> Unique Identifier 10651597 Medline Identifier 20104798 Authors Deyle GD. Henderson NE. Matekel RL. Ryder MG. Garber MB. Allison SC. Institution Brooke Army Medical Center and US Army-Baylor University, Fort Sam Houston, Texas 78234-6200, USA. gail.deyle@amedd.army.mil Title Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. [see comments.]. Comments Comment in: ACP J Club. 2000 Sep-Oct;133(2):57, Comment in: Ann Intern Med. 2000 Jun 6;132(11):923 ; 10836925 Source Annals of Internal Medicine. 132(3):173-81, 2000 Feb 1. Abstract BACKGROUND: Few investigations include both subjective and objective measurements of the effectiveness of treatments for osteoarthritis of the knee. Beneficial interventions may decrease the disability associated with osteoarthritis and the need for more invasive treatments. OBJECTIVE: To evaluate the effectiveness of physical therapy for osteoarthritis of the knee, applied by experienced physical therapists with formal training in manual therapy. DESIGN: Randomized, controlled clinical trial. SETTING: Outpatient physical therapy department of a large military medical center. PATIENTS: 83 patients with osteoarthritis of the knee who were randomly assigned to receive treatment (n = 42; 15 men and 27 women [mean age, 60 +/- 11 years]) or placebo (n = 41; 19 men and 22 women [mean age, 62 +/- 10 years]). INTERVENTION: The treatment group received manual therapy, applied to the knee as well as to the lumbar spine, hip, and ankle as required, and performed a standardized knee exercise program in the clinic and at home. The placebo group had subtherapeutic ultrasound to the knee at an intensity of 0.1 W/cm2 with a 10% pulsed mode. Both groups were treated at the clinic twice weekly for 4 weeks. MEASUREMENTS: Distance walked in 6 minutes and sum of the function, pain, and stiffness subscores of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A tester who was blinded to group assignment made group comparisons at the initial visit (before initiation of treatment), 4 weeks, 8 weeks, and 1 year. RESULTS: Clinically and statistically significant improvements in 6-minute walk distance and WOMAC score at 4 weeks and 8 weeks were seen in the treatment group but not the placebo group. By 8 weeks, average 6-minute walk distances had improved by 13.1% and WOMAC scores had improved by 55.8% over baseline values in the treatment group (P < 0.05). After controlling for potential confounding variables, the average distance walked in 6 minutes at 8 weeks among patients in the treatment group was 170 m (95% CI, 71 to 270 m) more than that in the placebo group and the average WOMAC scores were 599 mm higher (95% CI, 197 to 1002 mm). At 1 year, patients in the treatment group had clinically and statistically significant gains over baseline WOMAC scores and walking distance; 20% of patients in the placebo group and 5% of patients in the treatment group had undergone knee arthroplasty. CONCLUSIONS: A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention. <2> Unique Identifier 10865813 Medline Identifier 20324134 Authors Toda Y. Kobayashi T. Institution Toda Orthopedic Rheumatology Clinic, Osaka, Japan. fwjh2766@mb.infoweb.ne.jp Title The usefulness of walking for preventing sarcopenia in dieting postmenopausal women complaining of knee pain. Source Annals of the New York Academy of Sciences. 904:610-3, 2000 May. <3> Unique Identifier 10913058 Medline Identifier 20372485 Authors van den Ende CH. Breedveld FC. le Cessie S. Dijkmans BA. de Mug AW. Hazes JM. Institution Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands. vandenende@nivel.nl Title Effect of intensive exercise on patients with active rheumatoid arthritis: a randomised clinical trial. Source Annals of the Rheumatic Diseases. 59(8):615-21, 2000 Aug. Abstract OBJECTIVE: To investigate the effects of a dynamic, intensive exercise regimen on pain, disease activity, and physical functioning in active rheumatoid arthritis (RA). METHODS: 64 patients with RA with a mean age of 60 (13) years and mean disease duration of 8 (8) years, admitted to hospital because of active disease, were randomly assigned to an intensive exercise programme or to a conservative exercise programme during their period in hospital with a mean length of 30 (14) days. The intensive exercise programme consisted of knee and shoulder dynamic and isometric muscle strengthening exercises against resistance five times a week and conditioning bicycle training three times a week and was supplemental to the conservative exercise programme of range of motion and isometric exercises. Indices of disease activity, pain, muscle strength, and functional ability were assessed at 0, 3, 6, 12, and 24 weeks by a blinded observer. RESULTS: The medical treatment during the study was the same in both groups. Both groups improved in measures of disease activity, differences between groups were not statistically significant. The mean improvement in disease activity score at 24 weeks in the intensive and conservative exercise group was -1.4 (1. 5) and -0.7 (1.4), respectively. Measures of physical functioning improved significantly for patients in the intensive exercise group, and differences between groups were statistically significant for measures of muscle strength. CONCLUSION: A short term intensive exercise programme in active RA is more effective in improving muscle strength than a conservative exercise programme and does not have deleterious effects on disease activity. <4> Unique Identifier 11454639 Medline Identifier 21346912 Authors Sutton AJ. Muir KR. Mockett S. Fentem P. Institution Department of Epidemiology and Public Health, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK. ajs22@le.ac.uk Title A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Source Annals of the Rheumatic Diseases. 60(8):756-64, 2001 Aug. Abstract BACKGROUND: Physical activity is being recommended as an intervention for seemingly almost universal improvements to health. A potential concern with this recommendation for increased exercise is that some believe increased levels of activity may lead to increased incidence of osteoarthritis of the knee (knee OA), as a result of accelerated "wear and tear" of the major joints. OBJECTIVE: To investigate the hypothesis that the occurrence of knee OA may be related to the duration of participation in some forms of sport and active recreation. METHODS: The relation between habitual exercise, reported by a cross section of people surveyed in England, and self reported knee OA was investigated. Data were derived from the Allied Dunbar National Fitness Survey (1990-91). A matched retrospective case-control design was used and a new exposure classification system which categorised different grades of activities for different time periods for each subject's lifetime participation in regular physical activities was developed. Additional data on knee injuries sustained and bodily composition were also included in a multivariate analysis. RESULTS: From 4316 people originally interviewed, 216 eligible cases (66 men, 150 women) were identified (mean age 57.1). Each case was matched to four controls. When habitual sport/exercise participation were examined during a subject's life, only exposure to regular long walks and being physically active between the ages of 20 and 24 suggested any association with developing knee OA later in life. The only strong association found was a greatly increased risk of knee OA having previously sustained a knee injury (p<0.01, odds ratio 8.0 (95% confidence interval 2.0 to 32.0)). CONCLUSIONS: There was little evidence to suggest that increased levels of regular physical activity throughout life lead to an increased risk of knee OA later in life. Previous knee injury was associated with an increased risk of knee OA. Additionally, most injuries were caused through participation in physical activities. Hence, when deciding on participation in activities, it is worth taking the likelihood of joint injury into consideration, as the chance of injury is greater in some activities than others. <5> Unique Identifier 10857524 Medline Identifier 20313667 Authors Suomi R. Koceja DM. Institution School of Health, Exercise Science and Athletics, University of Wisconsin-Stevens Point, 54481, USA. Title Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Source Archives of Physical Medicine & Rehabilitation. 81(6):780-5, 2000 Jun. Abstract OBJECTIVE: To examine the reliability of postural sway assessment in women with lower extremity arthritis and to ascertain the effects of an aquatic exercise intervention program on these measures. DESIGN: The reliability of postural sway measures was analyzed by within-subjects (Subject times Trial) analysis of variance (ANOVA). The effects of aquatic exercise were analyzed by repeated measures ANOVA using a planned comparison approach with an independent 2 x 2 (Group times Test) design. SETTING: Testing in a motor control research laboratory; aquatic exercise in a warm water pool at an area YMCA. PARTICIPANTS: Volunteer sample, 24 women with lower extremity arthritis (rheumatoid [RA] n = 11, osteo [OA] n = 13) randomly assigned into an aquatic exercise group (n = 14) or control group (n = 10). INTERVENTION: Postural sway measures under a two-legged stance test on two separate test days: day 1, pretest; day 2, posttest, administered after a 6-week aquatic exercise program. RESULTS: Reliability correlation coefficients for postural sway measures ranged from .64 to .94 for both subject groups. Aquatic exercise subjects significantly reduced lateral sway and total sway area scores (by 18% to 30%) under both visual conditions after the 6-week intervention. Postural sway scores were significantly higher under the no-vision condition than under the vision condition in each group for both test sessions. Both OA and RA groups had normal sagittal/lateral ratio scores. CONCLUSION: Women with lower extremity arthritis can be reliably assessed on postural sway measures on a stable two-legged stance test. Although they had normal sagittal/lateral sway ratio scores (ie, scores typical for nonarthritic peers), vision played an important role in their postural stability for this balance task. Aquatic exercise reduced postural sway in women with lower extremity arthritis, as demonstrated by a two-legged stance test, and this exercise program appears to be a viable treatment for increasing postural stability in this population. <6> Unique Identifier 10403263 Medline Identifier 99330057 Authors van Baar ME. Assendelft WJ. Dekker J. Oostendorp RA. Bijlsma JW. Institution Netherlands Institute of Primary Health Care, Utrecht. Title Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. [Review] [57 refs] Source Arthritis & Rheumatism. 42(7):1361-9, 1999 Jul. Abstract OBJECTIVE: To review the effectiveness of exercise therapy in patients with osteoarthritis (OA) of the hip or knee. METHODS: A computerized literature search of Medline, Embase, and Cinahl was carried out. Randomized clinical trials on exercise therapy for OA of the hip or knee were selected if treatment had been randomly allocated and if pain, self-reported disability, observed disability, or patient's global assessment of effect had been used as outcome measures. The validity of trials was systematically assessed by independent reviewers. Effect sizes and power estimates were calculated. A best evidence synthesis was conducted, weighting the studies with respect to their validity and power. RESULTS: Six of the 11 assessed trials satisfied at least 50% of the validity criteria. Two trials had sufficient power to detect medium-sized effects. Effect sizes indicated small-to-moderate beneficial effects of exercise therapy on pain, small beneficial effects on both disability outcome measures, and moderate-to-great beneficial effects according to patient's global assessment of effect. CONCLUSION: There is evidence of beneficial effects of exercise therapy in patients with OA of the hip or knee. However, the small number of good studies restricts drawing firm conclusions. [References: 57] <7> Unique Identifier 11762684 Medline Identifier 21597765 Authors Westby MD. Institution Mary Pack Arthritis Program of Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada. Title A health professional's guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. [Review] [89 refs] Source Arthritis & Rheumatism. 45(6):501-11, 2001 Dec. <8> Unique Identifier 11263764 Medline Identifier 21161176 Authors Hakkinen A. Sokka T. Kotaniemi A. Hannonen P. Institution Central Finland Health Care District, Jyvaskyla, Finland. Title A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Source Arthritis & Rheumatism. 44(3):515-22, 2001 Mar. Abstract OBJECTIVE: To evaluate the impact of a 2-year program of strength training on muscle strength, bone mineral density (BMD), physical function, joint damage, and disease activity in patients with recent-onset (<2 years) rheumatoid arthritis (RA). METHODS: In this prospective trial, 70 RA patients were randomly assigned to perform either strength training (all major muscle groups of the lower and upper extremities and trunk, with loads of 50-70% of repetition maximum) or range of motion exercises (without resistance) twice a week; all were encouraged to engage in recreational activities 2-3 times a week. All patients completed training diaries (evaluated bi-monthly) and were examined at 6-month intervals. All were treated with medications to achieve disease remission. Maximum strength of the knee extensors, trunk flexors and extensors, and grip strength was measured with dynamometers. BMD was measured at the femoral neck and lumbar spine by dual x-ray densitometry. Disease activity was determined by the Disease Activity Score, the extent of joint damage by the Larsen score, and functional capacity by the Health Assessment Questionnaire (HAQ); walking speed was also measured. RESULTS: Sixty-two patients (31 per group) completed the study. Strength training compliance averaged 1.4-1.5 times/week. The maximum strength of all muscle groups examined increased significantly (19-59%) in the strength-training group, with statistically significant improvements in clinical disease activity parameters, HAQ scores, and walking speed. While muscle strength, disease activity parameters, and physical function also improved significantly in the control group, the changes were not as great as those in the strength-training group. BMD in the femoral neck and spine increased by a mean +/- SD of 0.51 +/- 1.64% and by 1.17 +/- 5.34%, respectively, in the strength-training group, but decreased by 0.70 +/- 2.25% and 0.91 +/- 4.07% in the controls. Femoral neck BMD in the 17 patients with high initial disease activity (and subsequent use of oral glucocorticoids) remained constantly at a statistically significantly lower level than that in the other 45 patients. CONCLUSION: Regular dynamic strength training combined with endurance-type physical activities improves muscle strength and physical function, but not BMD, in patients with early RA, without detrimental effects on disease activity. <9> Unique Identifier 11308067 Medline Identifier 21202264 Authors Takken T. van der Net J. Helders PJ. Institution Department of Pediatric Physical Therapy, University Hospital for Children and Youth, Het Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, The Netherlands. Title Do junvenile idiopathic arthritis patients benefit from an exercise program? A pilot study. Source Arthritis & Rheumatism. 45(1):81-5, 2001 Feb. <10> Unique Identifier 9667624 Medline Identifier 98330198 Authors Van den Ende CH. Vliet Vlieland TP. Munneke M. Hazes JM. Institution Department of Rheumatology, Leiden University Medical Center, The Netherlands. Title Dynamic exercise therapy in rheumatoid arthritis: a systematic review. [Review] [63 refs] Source British Journal of Rheumatology. 37(6):677-87, 1998 Jun. Abstract The aim of this systematic review was to determine the effectiveness of dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (RA). In addition, possible unwanted effects such as an increase in pain, disease activity and radiological progression were studied. A computer-aided search of the MEDLINE, Embase and SCISEARCH databases was performed to identify controlled trials on the effect of exercise therapy. Randomized trials were selected on the effect of dynamic exercise therapy in RA patients with an exercise programme fulfilling the following criteria: (a) intensity level such that heart rates exceeded 60% of maximal heart rate during at least 20 min; (b) exercise frequency > or = 2 a week; and (c) duration of intervention > or = 6 weeks. Two blinded reviewers independently selected eligible studies, rated the methodological quality and extracted data. Six out of 30 identified controlled trials met the inclusion criteria. Four of the six included studies fulfilled > or = 7/10 methodological criteria. Because of heterogeneity in outcome measures, data could not be pooled. The results suggest that dynamic exercise therapy is effective in increasing aerobic capacity and muscle strength. No detrimental effects on disease activity and pain were observed. The effects of dynamic exercise therapy on functional ability and radiological progression are unclear. It is concluded that dynamic exercise therapy has a positive effect on physical capacity. Research on the long-term effect of dynamic exercise therapy on radiological progression and functional ability is needed. [References: 63] <11> Unique Identifier 11049140 Medline Identifier 20500635 Authors Petrella RJ. Institution Department of Family Medicine, Faculty of Medicine, School of Kinesiology, University of Western Ontario, London, Canada. Title Is exercise effective treatment for osteoarthritis of the knee?. [Review] [31 refs] Source British Journal of Sports Medicine. 34(5):326-31, 2000 Oct. Abstract OBJECTIVE: To review and determine the effectiveness of exercise treatment in osteoarthritis of the knee. METHODS: A computerised literature search of Medline was carried out searching between June 1966 and January 2000. RESULTS: Twenty three randomised controlled trials were identified from the literature. Only three trials were sufficiently powered. Small to moderate beneficial effects of exercise treatment were found for pain, small beneficial effects on disability outcome measures, and moderate to great beneficial effects were observed according to patient global assessment of effect. It was not possible to obtain evidence on the content of exercise interventions, as studies were hampered by lack of attention to proper concealment, reporting of adverse effects, and long term effects of exercise treatment. The lack of standard outcomes measures is also noted. CONCLUSIONS: The available evidence indicates beneficial short term effects of exercise treatment in patients with osteoarthritis of the knee. However, the number of available studies is limited, and more research is needed to expand this recommendation. Specifically, additional trials should provide information on adherence, home based interventions, interaction with pharmacological treatments, functional outcomes measures relevant to exercise treatment in these patients, and long term effects. At present, doctors should recommend exercise to all patients with mild/moderate disease. Further study should be encouraged and exercise should be continued to be recommended as a mainstay of non-pharmacological treatment of osteoarthritis of the knee. [References: 31] <12> Unique Identifier 11450272 Medline Identifier 21344170 Authors Clyman B. Institution Department of Ambulatory Care, Greater Los Angeles VA Medical System, Los Angeles, CA, USA. Title Sports, exercise, and arthritis. [Review] [22 refs] Source Bulletin on the Rheumatic Diseases. 50(6):1-3, 2001. <13> Unique Identifier 9664110 Medline Identifier 98330430 Authors Ettinger WH Jr. Institution J. Paul Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. Title Physical activity, arthritis, and disability in older people. [Review] [46 refs] Source Clinics in Geriatric Medicine. 14(3):633-40, 1998 Aug. Abstract Physical activity protects against the development of chronic disease and disability. There appears to be little risk of damage to joints from regular, moderate-level exercise. Patients with arthritis can safely participate in exercise programs and often have relief of pain and disability. The most difficult problem facing practitioners is how to get people with arthritis to start and maintain an exercise program. [References: 46] <14> Unique Identifier 10796342 Medline Identifier 20257440 Authors Van Den Ende CH. Vliet Vlieland TP. Munneke M. Hazes JM. Institution NIVEL, Netherlands Institute of Primary Health Care, PO Box 1568, 3500 BN Utrecht, The Netherlands, 2300 RC. E.vandenEnde@nivel.nl Title Dynamic exercise therapy for rheumatoid arthritis. [Review] [7 refs] Source Cochrane Database Syst Rev. (2):CD000322, 2000. Abstract OBJECTIVES: To assess the effects of dynamic exercise therapy in improving joint mobility, muscle strength, aerobic capacity and daily functioning in patients with rheumatoid arthritis (RA). In addition, possible unwanted effects such as an increase in pain, disease activity and radiological progression were studied. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal trials register, the Cochrane Controlled trials Register, Medline, Embase and SCISEARCH databases up to may 1997 in order to controlled trials on the effect of exercise therapy. SELECTION CRITERIA: Randomized trials on the effect of dynamic exercise therapy in RA patients with an exercise program fulfilling the following criteria: a) intensity level such that heart rates exceeded 60% of maximal heart rate during at least 20 minutes, b) exercise frequency of two session per week, and c) duration of intervention of greater than six weeks DATA COLLECTION AND ANALYSIS: Two blinded reviewers independently selected eligible studies, rated the methodological quality and extracted data. MAIN RESULTS: Six out of 30 identified controlled trials met the inclusion criteria. Four of the six included studies fulfilled at least seven out of 10 methodological criteria. Due to heterogeneity in outcome measures, data could not be pooled. The results suggest that dynamic exercise therapy is effective at increasing aerobic capacity and muscle strength. No detrimental effects on disease activity and pain were observed. The effects of dynamic exercise therapy on functional ability and radiological progression are unclear. REVIEWER'S CONCLUSIONS: Dynamic exercise therapy has a positive effect on physical capacity. Research on the long-term effect of dynamic exercise therapy on radiological progression and functional ability is needed. [References: 7] <15> Unique Identifier 10990187 Medline Identifier 20443594 Authors Baker K. McAlindon T. Institution The Boston University Multipurpose Arthritis and Musculoskeletal Disease Center, Boston University School of Medicine, Massachusetts 02118, USA. krbaker@bu.edu Title Exercise for knee osteoarthritis. [Review] [70 refs] Source Current Opinion in Rheumatology. 12(5):456-63, 2000 Sep. Abstract Adverse outcomes in knee osteoarthritis include pain, loss of function, and disability. These outcomes can have devastating effects on the quality of life of those suffering from the disease. Treatments have generally targeted pain, assuming that disability would improve as a direct result of improvements in pain. However, there is evidence to suggest that determinants of pain and disability differ. In general, treatments have been more successful at decreasing pain rather than disability. Many of the factors that lead to disability can be improved with exercise. Exercise, both aerobic and strength training, have been examined as treatments for knee osteoarthritis, with considerable variability in the results. The variability between studies may be due to differences in study design, exercise protocols, and participants in the studies. Although there is variability among studies, it is notable that a majority of the studies had a positive effect on pain and or disability. The mechanism of exercise remains unclear and merits future studies to better define a concise, clear exercise protocol that may have the potential for a public health intervention. [References: 70] <16>
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