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Unique Identifier 10503663 Medline Identifier 99430988 Authors Lane NE. Buckwalter JA. Institution Division of Rheumatology, UCSF, San Francisco, CA 94142, USA. Title Exercise and osteoarthritis. [Review] [14 refs] Source Current Opinion in Rheumatology. 11(5):413-6, 1999 Sep. Abstract The relation of exercise to osteoarthritis is one of great interest and importance. In this paper, we review two recent studies. One reported that older individuals with normal knee and hip joints who jog for recreational activities do not have an increased risk for the development of osteoarthritis in weight-bearing joints. However, in another case-control study of women with hip osteoarthritis, the risk of hip osteoarthritis increased twofold with high levels of participation in recreational activities before the age of 50 years and fourfold for women with high levels of sporting activities and occupational physical loads. Therefore, participation in certain types of sporting activities and occupations that increase loading to the hip joint before the age of 50 years may be associated with an increased risk of hip osteoarthritis. However, recreational jogging in individuals 60 or more years of age with normal knee and hip joints does not increase the risk for the development of osteoarthritis. These studies add to our knowledge base regarding lifetime and current risk factors for the development of knee and hip osteoarthritis from exercise. [References: 14] <17> Unique Identifier 11709115 Medline Identifier 21566050 Authors Clyman B. Institution VA Greater Los Angeles Health Care System, 534 Hillgreen Drive, Beverly Hills, CA 90212, USA. clyman2@pacbell.net Title Exercise in the treatment of osteoarthritis. [Review] [23 refs] Source Current Rheumatology Reports. 3(6):520-3, 2001 Dec. Abstract 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. [References: 23] <18> Unique Identifier 11410766 Medline Identifier 21303290 Authors Resnick B. Institution University of Maryland School of Nursing in Baltimore, USA. Title Managing arthritis with exercise. [Review] [44 refs] Source Geriatric Nursing. 22(3):143-50, 2001 May-Jun. Abstract Almost half of all older adults have arthritis, either degenerative or inflammatory. Regular exercise is an important therapeutic intervention for all types of arthritis. Specifically, regular exercise can prevent deconditioning of the muscles, keep the joints stable, improve joint function and flexibility, decrease pain, enhance aerobic fitness, improve balance, and decrease falls. A comprehensive exercise program should include stretching exercises followed by a range-of-motion program for joints, muscle strengthening, and aerobic exercise, if possible. Unfortunately, despite these known benefits, most older adults with arthritis do not engage in regular exercise. The Seven Step Approach was developed to provide a practical framework to help overcome barriers and improve exercise activity in older adults with arthritis. [References: 44] <19> Unique Identifier 11100673 Medline Identifier 20552049 Authors Klippel J. Institution Arthritis Foundation, Atlanta, USA. Title Arthritis guidelines emphasize exercise. Source Health News. 6(11):3, 2000 Nov. <20> Unique Identifier 11232480 Medline Identifier 21123302 Authors Anonymous. Title An action plan for relieving joint pain. [Review] [0 refs] Source Johns Hopkins Medical Letter, Health After 50. 13(1):6-7, 2001 Mar. <21> Unique Identifier 10760643 Medline Identifier 20225934 Authors Cheng Y. Macera CA. Davis DR. Ainsworth BE. Troped PJ. Blair SN. Institution School of Public Health, University of South Carolina, Columbia, SC 29208, USA. Title Physical activity and self-reported, physician-diagnosed osteoarthritis: is physical activity a risk factor?. Source Journal of Clinical Epidemiology. 53(3):315-22, 2000 Mar 1. Abstract This prospective study evaluated regular physical activity and self-reported physician-diagnosed osteoarthritis of the knee and/or hip joints among 16,961 people, ages 20-87, examined at the Cooper Clinic between 1970 and 1995. Among those aged 50 years and older, osteoarthritis incidence was higher among women (7.0 per 1000 person-years) than among men (4.9 per 1000 person-years, P = 0.001), while among those under 50 years of age, osteoarthritis incidence was similar between men (2.6) and women (2.7). High levels of physical activity (running 20 or more miles per week) were associated with osteoarthritis among men under age 50 after controlling for body mass index, smoking, and use of alcohol or caffeine (hazard ratio = 2.4, 95% CI: 1.5, 3.9), while no relationship was suggested among women or older men. These findings support the conclusion that high levels of physical activity may be a risk factor for symptomatic osteoarthritis among men under age 50. <22> Unique Identifier 10855749 Medline Identifier 20312439 Authors Kelley MJ. Ramsey ML. Institution Occupational and Physical Therapy Department, University of Pennsylvania Health System, Philadelphia, USA. Title Osteoarthritis and traumatic arthritis of the shoulder. [Review] [33 refs] Source Journal of Hand Therapy. 13(2):148-62, 2000 Apr-Jun. Abstract Glenohumeral osteoarthritis and traumatic arthritis result in a painful shoulder with impairments, functional deficits, and disability. Conservative treatment includes oral inflammatory medication, cortisone injection, or rehabilitation. Rehabilitation of the shoulder can be beneficial, but if joint destruction is advanced, surgery may be required. Postoperative rehabilitation requires the therapist to know the basics of the surgical technique so that safe and effective therapeutic intervention can be made. A successful outcome depends on effective communication and interaction among the physician, therapist, and patient. Each "team" member has a defined role in rehabilitation, and all three must fulfill their responsibilities for the desired outcome to be achieved. [References: 33] <23> Unique Identifier 10855751 Medline Identifier 20312441 Authors Lockard MA. Institution Department of Physical Therapy, Temple University, Philadelphia, Pennsylvania 19040, USA. Title Exercise for the patient with upper quadrant osteoarthritis. [Review] [26 refs] Source Journal of Hand Therapy. 13(2):175-83, 2000 Apr-Jun. <24> Unique Identifier 11484101 Medline Identifier 21376346 Authors Toda Y. Institution Toda Orthopedic Rheumatology Clinic, 14-1 Toyotsu-cho, Suita, Osaka 564-0051, Japan. Title The effect of energy restriction, walking, and exercise on lower extremity lean body mass in obese women with osteoarthritis of the knee. Source Journal of Orthopaedic Science. 6(2):148-54, 2001. Abstract Two hundred and twenty-eight Japanese women, aged 45-69 years, with osteoarthritis of the knee (knee OA) and a body mass index of greater than 26.4 self-selected one of the following interventions: (1) a nonsteroidal anti-inflammatory drug (NSAID) alone (NA group; n = 52), (2) the NSAID with nonweight-bearing exercises (NE; n = 49), (3) the NSAID combined with walking (NW; n = 35), (4) an energy restriction diet plus the NSAID (ND; n = 29), (5) the diet combined with the NSAID and strengthening exercises (NDE; n = 37), or (6) the diet combined with the NSAID and walking (NDW; n = 26). Body weight and lower extremity lean body mass (L-LBM), assessed with segmental bioelectrical impedance, were measured at the outset and at 8 weeks in the six therapy groups. Interval changes in L-LBM and L-LBM per body weight (L-LBM/weight) were compared among the six groups at the conclusion. The Lequesne index can index of severity of osteoarthritis of the knee at the final assessment, compared with that at the initial assessment, was significantly decreased in the NE group, but not in the NW or the NA groups (P = 0.023). There was a significant increase in the L-LBM/weight in the NE group, but not in the NA or NW groups (P = 0.002 between NE and NA; P = 0.019 between NE and NW). There was a significant reduction in the Lequesne index in the NDE group in comparison with the ND and NDW groups (P = 0.0001 between NDE and ND; P = 0.0001 between NDE and NDW). There was a significant increase in L-LBM/weight in the NDE group, but not in the NDW or the ND groups (P = 0.011). Adjunctive therapy with nonweight-bearing lower extremity exercises appears to be more efficacious for prevention of lower extremity loss of muscle mass than adjunctive therapy with walking for obese women with knee OA. <25> Unique Identifier 11196520 Medline Identifier 21038661 Authors Melzer I. Yekutiel M. Sukenik S. Institution Faculty of Health Sciences, Ben-Gurion University of the Negev, and Department of Internal Medicine D, Soroka University Medical Center, Beer-Sheeva, Israel. Title Comparative study of osteoarthritis of the contralateral knee joint of male amputees who do and do not play volleyball. Source Journal of Rheumatology. 28(1):169-72, 2001 Jan. Abstract OBJECTIVE: To assess the prevalence of osteoarthritis (OA) of the contralateral knee of men with traumatic amputation who do and do not participate in regular, vigorous physical activity. METHODS: Three groups of patients were assessed. Group 1 consisted of 8 male amputee volleyball players. Group 2 consisted of 24 male amputees who do not play volleyball, and Group 3 was made up of 24 healthy controls matched by age and weight to Group 2. The prevalence of contralateral knee OA in Groups 1 and 2 was assessed by questionnaire, physical examination, and radiographs, and was compared with findings for Group 3. RESULTS: The rate of OA in all amputees (Groups 1 and 2 together) was 65.6%, which was significantly higher than among the controls (p < 0.05). The most common findings among the amputees were patellar and medial osteophytosis of the tibiofemoral joint, with a tendency to medial narrowing of the tibiofemoral joint space. CONCLUSION: Traumatic amputees have a higher prevalence of OA in the knee of the nonamputated leg than matched healthy controls. <26> Unique Identifier 10914850 Medline Identifier 20370534 Authors Westby MD. Wade JP. Rangno KK. Berkowitz J. Institution Physical Therapy Department, Vancouver Hospital and Health Sciences Centre, British, Columbia, Canada. Title A randomized controlled trial to evaluate the effectiveness of an exercise program in women with rheumatoid arthritis taking low dose prednisone. Source Journal of Rheumatology. 27(7):1674-80, 2000 Jul. Abstract OBJECTIVE: To evaluate the effects of a 12 month, weight bearing, aerobic exercise program on disease activity, physical function, and bone mineral density (BMD) in women with rheumatoid arthritis (RA) taking low dose prednisone. METHODS: A group of women with RA (n = 23) not receiving steroid therapy and in American College of Rheumatology functional class I or II was compared to 30 steroid treated patients with similar demographics. The latter group was randomized to usual care (n = 16) or an aerobic, weight bearing exercise program (n = 14) 3 times a week for 12 months. All subjects were recruited from an outpatient rheumatology clinic or physical therapy department and met the study inclusion criteria. Outcome measures included disease activity (erythrocyte sedimentation rate, active joint count), physical function (Health Assessment Questionnaire disability index, activity level) and BMD of the spine and femoral neck (by dual energy projection radiology). RESULTS: Subjects in the exercise group had a small but nonsignificant decrease in disease activity and statistically significant improvements in function (p = 0.05) and activity levels (p = 0.05). BMD remained unchanged in the exercise group, decreased significantly (p = 0.004) in the nonsteroid comparison group (hip), and changed nonsignificantly in the control group. However, between-group changes in spinal BMD of the steroid treated groups was not significant (p = 0.09). CONCLUSION: Women with RA taking low dose steroid therapy can safely participate in a dynamic, weight bearing exercise program with positive effects on their physical function, activity and fitness levels, and BMD with no exacerbation of disease activity. <27> Unique Identifier 11710661 Medline Identifier 21566900 Authors Wyatt FB. Milam S. Manske RC. Deere R. Institution Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas 76798, USA. Title The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. Source Journal of Strength & Conditioning Research. 15(3):337-40, 2001 Aug. Abstract The purpose of the study was to detect if increases in functional levels for patients with osteoarthritis show differences between an aquatic exercise program and a land-based exercise program. Forty-six subjects between the ages of 45 and 70 years participated in 1 of 2 exercise groups. Pre- and posttest measurements included knee range of motion (ROM), thigh girth, subjective pain scale, and time for a 1-mile walk. Both exercise groups showed a significant (p < 0.05) increase in all measurements between pre- and posttests. There were no significant differences between the aquatic exercise group and the land-based exercise group pertaining to knee ROM, thigh girth, and time for a 1-mile walk. Subjective pain levels were significantly less in the aquatic group when compared with the land-based group. This study concludes that both aquatic and land-based exercise programs are beneficial to patients with osteoarthritis. <28> Unique Identifier 11480416 Medline Identifier 21372731 Authors American Geriatrics Society Panel on Exercise and Osteoarthritis. Title Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. A supplement to the AGS Clinical Practice Guidelines on the management of chronic pain in older adults. [Review] [191 refs] Source Journal of the American Geriatrics Society. 49(6):808-23, 2001 Jun. <29> Unique Identifier 10983905 Medline Identifier 20437199 Authors Messier SP. Loeser RF. Mitchell MN. Valle G. Morgan TP. Rejeski WJ. Ettinger WH. Institution Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina 27109, USA. Title Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Source Journal of the American Geriatrics Society. 48(9):1062-72, 2000 Sep. Abstract OBJECTIVE: The purposes of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis, and to compare the effects of exercise plus dietary therapy with exercise alone on gait, strength, knee pain, biomarkers of cartilage degradation, and physical function. DESIGN: Single-blind, two-arm, randomized clinical trial conducted for 24 weeks. SETTING: A university health and exercise science center. PARTICIPANTS: Twenty-four community-dwelling obese older adults aged > or = 60 years, body mass index > or = 28, knee pain, radiographic evidence of knee osteoarthritis, and self-reported physical disability. INTERVENTION: Randomization into two groups: exercise and diet (E&D) and exercise alone (E). Exercise consisted of a combined weight training and walking program for 1 hour three times per week. The dietary intervention included weekly sessions with a nutritionist utilizing cognitive-behavior modification to change dietary habits to reach a group goal of an average weight loss of 15 lb (6.8 kg) over 6 months. MEASUREMENTS: All measurements were conducted at baseline and 3 and 6 months, except for synovial fluid analysis, which was obtained only at baseline and 6 months. In addition, weight was measured weekly in the E&D group. Physical disability and knee pain were measured by self-report and physical performance was measured using the 6-minute walk and stair climb tasks. Biomechanical testing included kinetic and kinematic analysis of gait and isokinetic strength testing. Synovial fluid was analyzed for levels of total proteoglycan, keratan sulfate, and interleukin-1 beta. RESULTS: Twenty-one of the 24 participants completed the study, with one dropout in the E&D group and two in the E group. The E&D group lost a mean of 18.8 lb (8.5 kg) at 6 months compared with 4.0 lb (1.8 kg) in the E group (P = .01). Significant improvements were noted in both groups in self-reported disability and knee pain intensity and frequency as well as in physical performance measures. However, no statistical differences were found between the two groups at 6 months in knee pain scores or self-reported performance measures of physical function. There was no difference in knee strength between the groups, with both groups showing modest improvements from baseline to 6 months. At 6 months, the E&D group had a significantly greater loading rate (P = .03) and maximum braking force (P = .01) during gait. There were no significant between-group differences in the other biomechanical measures. Synovial fluid samples were obtainable at both baseline and 6 months in eight participants (four per group). The level of keratan sulfate decreased similarly in both groups from an average baseline of 96.8 +/- 37.1 to 71.5 +/- 23 ng/microg total proteoglycan. The level of IL-1 decreased from 25.3 +/- 9.8 at baseline to 8.3 +/- 6.1 pg/mL. The decrease in IL-1 correlated with the change in pain frequency (r = -0.77, P = .043). CONCLUSIONS: Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention. Both exercise and combined weight loss and exercise regimens lead to improvements in pain, disability, and performance. Moreover, the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone. A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population. <30> Unique Identifier 11480416 Medline Identifier 21372731 Authors American Geriatrics Society Panel on Exercise and Osteoarthritis. Title Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. A supplement to the AGS Clinical Practice Guidelines on the management of chronic pain in older adults. [erratum appears in J Am Geriatr Soc 2001 Oct;49(10):1400.]. [Review] [191 refs] Source Journal of the American Geriatrics Society. 49(6):808-23, 2001 Jun. <31> Unique Identifier 10682941 Medline Identifier 20145146 Authors Messier SP. Royer TD. Craven TE. O'Toole ML. Burns R. Ettinger WH Jr. Institution Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina 27109, USA. Title Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the Fitness, Arthritis, and Seniors Trial (FAST). Source Journal of the American Geriatrics Society. 48(2):131-8, 2000 Feb. Abstract OBJECTIVES: To examine the effects of 18-month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis. DESIGN: Randomized, single-blind, clinical trial of therapeutic exercise. SETTING: Both center-based (university) and home-based. PARTICIPANTS: A cohort of 103 older adults (age = 60 years) with knee osteoarthritis who were participants in a large (n = 439) clinical trial and who were randomly assigned to undergo biomechanical testing. INTERVENTION: An 18-month center- (3 months) and home-based (15 months) therapeutic exercise program. The subjects were randomized to one of three treatment arms: (1) aerobic walking; (2) health education control; or (3) weight training. MEASUREMENTS: Force platform static balance measures of average length (Rm) of the center of pressure (COP), average velocity (Vel) of the COP, elliptical area (Ae) of the COP, and balance time (T). Measures were made under four conditions: eyes open, double- and single-leg stances and eyes closed, double- and single-leg stances. RESULTS: In the eyes closed, double-leg stance condition, both the aerobic and weight training groups demonstrated significantly better sway measures relative to the health education group. The aerobic group also demonstrated better balance in the eyes open, single-leg stance condition. CONCLUSIONS: Our results suggest that long-term weight training and aerobic walking programs significantly improve postural sway in older, osteoarthritic adults, thereby decreasing the likelihood of larger postural sway disturbances relative to a control group. <32> Unique Identifier 11867660 Medline Identifier 21856693 Authors Penninx BW. Rejeski WJ. Pandya J. Miller ME. Di Bari M. Applegate WB. Pahor M. Institution Sticht Center on Aging, Department of Internal Medicine. Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. bpenninx@wfubmc.edu Title Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. Source Journals of Gerontology Series B-Psychological Sciences & Social Sciences. 57(2):P124-32, 2002 Mar. Abstract This study examines and compares the effect of aerobic and resistance exercise on emotional and physical function among older persons with initially high or low depressive symptomatology. Data are from the Fitness, Arthritis and Seniors Trial, a trial among 439 persons 60 years or older with knee osteoarthritis randomized to health education (control), resistance exercise, or aerobic exercise groups. Depressive symptoms (assessed by the Center for Epidemiologic Studies--Depression scale) and physical function (disability, walking speed, and pain) were assessed at baseline and after 3, 9, and 18 months. Compared with results for the control group, aerobic exercise significantly lowered depressive symptoms over time. No such effect was observed for resistance exercise. The reduction in depressive symptoms with aerobic exercise was found both among the 98 participants with initially high depressive symptomatology and among the 340 participants with initially low depressive symptomatology and was the strongest for the most compliant persons. Aerobic and resistance exercise significantly reduced disability and pain and increased walking speed both, and to an equal extent, in persons with high depressive symptomatology and persons with low depressive symptomatology. <33> Unique Identifier 10028913 Medline Identifier 99153289 Authors Anonymous. Title Arthritis. New treatments and daily decisions are keys to an active lifestyle. [Review] [0 refs] Source Mayo Clinic Health Letter. Suppl:1-6, 8, 1999 Feb. <34> Unique Identifier 11317090 Medline Identifier 21216849 Authors Patrick DL. Ramsey SD. Spencer AC. Kinne S. Belza B. Topolski TD. Institution Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. donald@u.washington.edu Title Economic evaluation of aquatic exercise for persons with osteoarthritis. [see comments.]. Comments Comment in: Med Care. 2001 May;39(5):409-12 ; 11317089 Source Medical Care. 39(5):413-24, 2001 May. Abstract OBJECTIVES: To estimate cost and outcomes of the Arthritis Foundation aquatic exercise classes from the societal perspective. DESIGN: Randomized trial of 20-week aquatic classes. Cost per quality-adjusted life year (QALY) gained was estimated using trial data. Sample size was based on 80% power to reject the null hypothesis that the cost/QALY gained would not exceed $50,000. SUBJECTS AND METHODS: Recruited 249 adults from Washington State aged 55 to 75 with a doctor-confirmed diagnosis of osteoarthritis to participate in aquatic classes. The Quality of Well-Being Scale (QWB) and Current Health Desirability Rating (CHDR) were used for economic evaluation, supplemented by the arthritis-specific Health Assessment Questionnaire (HAQ), Center for Epidemiologic Studies-Depression Scale (CES-D), and Perceived Quality of Life Scale (PQOL) collected at baseline and postclass. Outcome results applied to life expectancy tables were used to estimate QALYs. Use of health care facilities was assessed from diaries/questionnaires and Medicare reimbursement rates used to estimate costs. Nonparametric bootstrap sampling of costs/QALY ratios established the 95% CI around the estimates. RESULTS: Aquatic exercisers reported equal (QWB) or better (CHDR, HAQ, PQOL) health-related quality of life compared with controls. Outcomes improved with regular class attendance. Costs/QALY gained discounted at 3% were $205,186 using the QWB and $32,643 using the CHRD. CONCLUSION: Aquatic exercise exceeded $50,000 per QALY gained using the community-weighted outcome but fell below this arbitrary budget constraint when using the participant-weighted measure. Confidence intervals around these ratios suggested wide variability of cost effectiveness of aquatic exercise. <35>

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