Move It or Lose It: Exercise and Osteoarthritis
April 30, 1997 3 minutes read
Move It or Lose It: Exercise and Osteoarthritis
ABSTRACT & COMMENTARY
Synopsis: Osteoarthritis sufferers assigned to aerobic or weight training exercise programs had about 8-12% less disability and pain when compared to comparable subjects with osteoarthritis of the knee who were not assigned to an exercise group.
Source: Ettinger WH, et al. JAMA 1997;277:25-31.
Exercise, diet, vitaminsis this the mantra of the self actualized patient of the ’90s? If I do not address these topics during a consultation, many patients will ask about the usefulness of these three interventions in arthritis care. In management guidelines for those with osteoarthritis (OA), the American College of Rheumatology has recommended exercise.1 Now, a large community-based trial of aerobic exercise or resistive exercise has been compared in a prospective, randomized trial with a control group who receive health education. All three groups had radiographically proven OA of the knee, pain, some disability due to arthritis, and were aged 60 years or older. After baseline examination and treadmill exercise testing, 439 patients were enrolled. The exercise interventions were conducted with small groups at central facilities three times a week for the first three months and then were to be continued by the subjects in their community with the encouragement of home visits and telephone calls. Aerobic exercise consisted of 10 minutes of warm-up stretching, 40 minutes of walking, and a 10-minute cool-off period. Resistive exercise was conducted with free weights and ankle weights with gradual increases in the amount of weight as training progressed. The control group received arthritis health education, in monthly small groups for the first three months and phone follow-up thereafter. The arthritis health education included information about the beneficial effects of exercise. The primary outcome measure was the subject’s self-reported level of disability, which included 23 activities of daily living, each scored on a five-point scale with adjustment for prerandomization disability score, body mass index, and log of peak oxygen consumption on baseline exercise testing. Secondary measures included pain and timed task performance (6-minute walking distance, stairs, carrying, entering and exiting a car).
The aerobic exercise group had 10% less and the resistive exercise group 8% less self-reported disability at the end of 18 weeks of study than the control group, which received arthritis health education. Both exercise groups also reported less pain at the end of the 18-month intervention than did the education controls (aerobic, 12% less; resistive, 8% less). (See Figure.) Despite telephone follow-up, roughly 50% of the subjects assigned to the exercise groups had stopped exercising by the end of the trial.
A few adverse events occurred, with four falls and one dropped dumbbell resulting in two fractures. However, one subject assigned to arthritis health education died suddenly while walking from her car to a group meeting. Subgroup analysis performed by the authors confirmed a dose response with improved disability scores correlating in a positive fashion with the amount of compliance with the exercise program. Finally, the group assigned aerobic exercise increased their maximal oxygen consumption measured on exercise testing at the end of the trial compared to baseline. Neither the resistive exercise nor education control group had any significant change in maximal oxygen consumption.
COMMENT BY JERRY M. GREENE, MD
Less pain and less disability for those who exercised either by walking or training with weightsthis is good news. It is discouraging that only half the subjects assigned to exercise were still doing it after 18 months, despite a very intensive program of instruction, home visits, and telephone calling. This is not good news, especially for those of us who do not have the wherewithal to make home visits, run group exercise sessions, or make encouraging phone calls to all our OA patients. Based upon this study, one can advise patients that, in general, a regular program of aerobic exercise will be of benefit to them, not only from a cardiovascular standpoint, but because of expected improvement in their pain and bother from OA. Although advice provided in an office encounter is unlikely to be as effective as the intensive attention provided to the subjects in the exercise groups in this study, it is still better than nothingand clearly better than telling patients with OA not to exercise.
Reference
1. Hochberg MC, et al. Arthritis Rheum 1995;38: 1541-1546.
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