ArticleLiterature Review

Strength Training in Older Adults: The Benefits for Osteoarthritis

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

This review summarizes the findings of randomized controlled trials of progressive resistance training (PRT) by older people with osteoarthritis (OA). A significant benefit was found in lower-extremity extensor strength, function, and pain reduction. Across all 3 outcomes, the estimated effect size was moderate, which contrasted with trials of PRT in non-OA-specific groups of older adults where a large effect was found in strength but a small effect on function. This suggests that strength training has strong functional benefits for older adults with OA. Older adults with OA benefit from a strength-training program that provides progressive overload to maintain intensity throughout an exercise program.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Muscle weakness is a characteristic of patients with KOA (de Zwart et al., 2015), and is a better predictor of disability than pain or joint space narrowing . Most adults attain their peak muscle strength in their mid-20s and maintain this level until their 60s, but in their 80s, their muscle strength drops to only half of their peak (Latham and Liu, 2010). Muscle weakness may be caused by muscle dysfunction and may be a risk factor for the progression of KOA . ...
... The most apparent muscle weakness is the decrease in extension and flexion strength (Heiden et al., 2009). Extensor weakness is common in patients with KOA, especially quadriceps weakness, which could lead to an increased risk of functional limitation and disability (Latham and Liu, 2010;Jegu et al., 2014). There is an atrophy of the type I and type II fibers of the vastus medialis muscle in patients with end-stage KOA who underwent total knee replacement (Fink et al., 2007). ...
... Long-term weakness of the quadriceps can accelerate the progression of degenerative KOA . A 6-year cohort study showed that increasing knee muscle strength can prevent the development of KOA-related dysfunction (Latham and Liu, 2010). Increasing the strength of the quadriceps and resisting muscle weakness can relieve the degeneration associated with KOA (Segal et al., 2012). ...
Article
Full-text available
Knee osteoarthritis is a chronic degenerative disease. Cartilage and subchondral bone degeneration, as well as synovitis, are the main pathological changes associated with knee osteoarthritis. Mechanical overload, inflammation, metabolic factors, hormonal changes, and aging play a vital role in aggravating the progression of knee osteoarthritis. The main treatments for knee osteoarthritis include pharmacotherapy, physiotherapy, and surgery. However, pharmacotherapy has many side effects, and surgery is only suitable for patients with end-stage knee osteoarthritis. Exercise training, as a complementary and adjunctive physiotherapy, can prevent cartilage degeneration, inhibit inflammation, and prevent loss of the subchondral bone and metaphyseal bone trabeculae. Increasing evidence indicates that exercise training can improve pain, stiffness, joint dysfunction, and muscle weakness in patients with knee osteoarthritis. There are several exercise trainings options for the treatment of knee osteoarthritis, including aerobic exercise, strength training, neuromuscular exercise, balance training, proprioception training, aquatic exercise, and traditional exercise. For Knee osteoarthritis (KOA) experimental animals, those exercise trainings can reduce inflammation, delay cartilage and bone degeneration, change tendon, and muscle structure. In this review, we summarize the main symptoms of knee osteoarthritis, the mechanisms of exercise training, and the therapeutic effects of different exercise training methods on patients with knee osteoarthritis. We hope this review will allow patients in different situations to receive appropriate exercise therapy for knee osteoarthritis, and provide a reference for further research and clinical application of exercise training for knee osteoarthritis.
... When properly performed, strength training can provide functional benefits in physical well-being, including increased bone, muscle, tendon and ligament strength, improved joint function and reduced potential for injury. Muscle weakness is common in people with OA and is associated with an increased risk of functional limitations and disability [36][37][38][39][40][41][42], and there is evidence that muscle weakness contributes to the development and progression of OA [42]. In the elaboration of this present review, we realized that the clinical trials regarding the treatment of mild OA through strength training are very different in their protocols; in fact, they analyze participants with very different characteristics, such as age, sex, severity of OA, duration of the training, and in addition, the strength training is often combined with other clinical practices or physical exercises. ...
... When properly performed, strength training can provide functional benefits in physical well-being, including increased bone, muscle, tendon and ligament strength, improved joint function and reduced potential for injury. Muscle weakness is common in people with OA and is associated with an increased risk of functional limitations and disability [36][37][38][39][40][41][42], and there is evidence that muscle weakness contributes to the development and progression of OA [42]. In the elaboration of this present review, we realized that the clinical trials regarding the treatment of mild OA through strength training are very different in their protocols; in fact, they analyze participants with very different characteristics, such as age, sex, severity of OA, duration of the training, and in addition, the strength training is often combined with other clinical practices or physical exercises. ...
... Data from the literature show that muscle strength of the knee flexors and extensors increases with strength training [30,51,52], and improvements in symptoms and function are directly related to exercise intensity [30,50]. Variety in the exercise program should be provided by using different leg exercises or by substituting free weight exercise [30,50], but there is no evidence that one type of strength training is superior to another, so that OA patients should exercise at the intensity, location and using the equipment that they most prefer [42]. ...
Article
Osteoarthritis (OA) is a degenerative disease of the articular cartilage, and it represents one of the most common causes of disability in the world. It leads to social, psychological and economic costs with financial consequences. Different OA treatments are usually considered in relation to the stage of the disease, such as surgical management, pharmacologic and non-pharmacologic treatments. In relation to mild OA, non-pharmacologic and behavioral treatments are recommended because they are less invasive and better tolerated by patients. All of these treatments used to manage OA are problematic, but solutions to these problems are on the horizon. For this reason, we decided to realize this report because until today, there has been very little information regarding the physical treatment of this important disease to help medical doctors and patients in the choice of the best adapted training to manage pain and disability limitations in patients with OA. The aim of this review is to find some answer in the management of OA through physical therapy treatment. In the present review, we analyze data from the most recent literature in relation to the effects of physical exercise on mild OA. All data suggest that training exercise is considered an effective instruments for the treatment of mild OA. The literature search was conducted on PubMed, using appropriate keywords in relation to exercise and osteoarthritis.
... In patients with KOA, KE muscle weakness has been correlated with knee pain and functional disability (Roos et al. 2011). Progressive muscle RT can lead to significant improvements in older adults with KOA (Latham and Liu, 2010) by ameliorating sarcopenic changes and by improving the strength and function of the surrounding connective tissue, which is often damaged by OA (Latham and Liu, 2010). ...
... In patients with KOA, KE muscle weakness has been correlated with knee pain and functional disability (Roos et al. 2011). Progressive muscle RT can lead to significant improvements in older adults with KOA (Latham and Liu, 2010) by ameliorating sarcopenic changes and by improving the strength and function of the surrounding connective tissue, which is often damaged by OA (Latham and Liu, 2010). ...
... do not participate RT because of barriers such as fear of falling(Lees et al. 2005) or present with comorbidities that often preclude the usage of HL-RT(Liu and Latham, 2010). Novel and effective forms of exercise strategies are needed to induce similar neuromuscular adaptations as HL-RT(Vechin et al. 2015).A recent systematic review and meta-analysis byHughes et al. (2017) showed that BFRT increased muscle strength with moderate effect (Hedges'g=0.52, ...
Thesis
Full-text available
[Motivation] Quadriceps or knee extensor weakness is considered not only as an important risk factor for osteoarthritis but also as the main determinant of physical function with knee osteoarthritis (KOA). Low-load resistance training with blood flow restriction training (BFRT) has previously shown to improve knee extensor strength whilst reducing risk of incident symptomatic KOA. BFRT could offer comparable increases in muscle size and strength as observed with traditional, high-load resistance training (HL-RT). BFRT may be a clinically relevant musculoskeletal rehabilitation modality as it does not require the high joint forces associated with HL-RT. [Research Focus] The focus of this dissertation was to elucidate the role of BFRT as a nonpharmacologic intervention for improving muscle strength and functionality in adults diagnosed with KOA. [Research Methods] These research aims were met through an extensive review of relevant literature pertaining to blood flow restriction training in KOA sufferers. [Findings] The findings from this dissertation provided promising evidence that BFRT to be safe and potentially effective in improving quadriceps strength in patients with knee-related weakness and atrophy. [Conclusion] The main conclusion drawn from this literature review is that BFRT could provide an equally effective and more tolerable approach to HL-RT whilst increasing knee extensor strength in symptomatic KOA patients. [Recommendation] This dissertation recommends that future research should determine whether changes in BFRT training dose or duration may improve quadriceps muscle cross-sectional area in KOA patients.
... However when comparing rehabilitation programs, there is little evidence for outcomes that are related to changes in muscle strength, which can be defined as the ability of muscle to exert force 16 , or indicators of muscle strength (e.g., muscle size). A single systematic review involving meta-analysis 17 that compared various rehabilitation programs in a population with knee and/or hip OA identified improvements in knee extension strength in favour of resistance exercise when compared to alternative interventions. However, the combination of the 'alternate intervention' group with control group data potentially dilutes the influence of the alternative intervention and inflates the effect size of the resistance programs. ...
... Similar results for functional outcomes were reported in a systematic review by Roddy et al. 77 when comparing aerobic exercise with strengthening exercises in people with knee OA. In contrast, the review by Latham et al. 17 identified improvements in knee extension strength in favour of resistance exercise when compared to alternative interventions. However as identified previously, the dilution of the "alternative intervention" group with control group data could have lead to the conflicting results in this review. ...
Article
To analyse the effect of exercise-based rehabilitation programs for improving lower limb muscle strength in individuals with hip or knee osteoarthritis (OA). A systematic search utilizing seven databases identified randomized controlled trials (RCTs) evaluating lower limb strength outcomes of exercise-based interventions for participants with hip or knee OA. All studies were screened for eligibility and methodological quality. Quality of evidence was assessed using GRADE. Data were pooled and meta-analyses performed where appropriate. Forty RCTs were included and the majority (77%) involved resistance based exercise programs. For knee OA populations, there was high quality evidence for improved knee extension (SMD=0.47, 95% CI 0.29, 0.66) and flexion strength (SMD=0.74, 95% CI 0.56, 0.92) with low-intensity resistance program when compared to a control at short term follow-up. There was moderate quality evidence for a large effect favouring high-intensity resistance programs (SMD=0.76, 95% CI 0.47, 1.06) when compared to a control. This effect was sustained at intermediate term follow-up (SMD=0.80, 95%CI 0.44, 1.17). Few studies reported on outcomes at long term follow-up. Only one study reported on a population with hip OA. When compared to a control group, high-intensity resistance exercise demonstrated moderate quality of evidence for large and sustained improvements for knee muscle strength in knee OA patients. Further work is needed to compare different modes of exercise at a long term follow-up for knee OA patients and to address the dearth of literature evaluating exercise interventions in people with hip OA.
... Impressively, weightlifting has also been shown to benefit both older adults and adolescents, two groups for which there was once reluctance in advising participation in resistance training. In older adults, resistance training has been specifically shown to help manage osteoarthritis; in adolescents, improvements in motor skills and more healthful body compositions have similarly been reported [3,4]. In part, this has led to a significant increase in its national popularity, with about 45 % of the population having reported that they participated in weightlifting in 2011 [5]. ...
... For example, there may be a greater pool of individuals participating in weightlifting today than in the past. Recent trends in global exercise habits have demonstrated that more and more people are regularly incorporating strength training into their workouts, concordant with emerging evidence that it can yield health benefits for people of all ages [2,4,17]. As middle-aged and ▶Fig. ...
Article
Weightlifting is associated with a significant risk of shoulder injury. We used the National Electronic Injury Surveillance System (NEISS) database to identify patients presenting to U.S. emergency departments between 2000 and 2017 with weightlifting-associated shoulder injuries to determine how the health burden and demographic characteristics of these patients have changed over time. Our analyses demonstrated a significant increase in the national estimate of weightlifting-associated shoulder injuries between 2000 (N=8.073; C.I. 6.309–9.836) and 2017 (N=14.612; C.I. 12.293–16.930) (p<0.001), with linear regression (R2=0.87, P<0.001) projecting 22.691 national cases by 2030. Patients were most often males (83.3%; C.I. 81.5–85.2%) between 20–29 years of age (30.5%; C.I. 28.2%–32.8%) sustaining a sprain, strain, or muscle tear (65.1%; C.I. 60.4–69.8%). Additionally, the average age of injury (34.33 years; C.I. 33.43–35.23 years) in the 2012–2017 period was significantly higher than in prior periods (p<0.001). We postulated these findings may reflect older individuals more frequently participating in resistance training than in the past, and considered that contemporary fitness trends such as CrossFit might have higher injury rates. We believe increased awareness of this burden, coupled with focus on injury prevention strategies, could yield substantial national health and cost savings.
... Physical exercise had been used in conjunction with pharmacological treatments. No pharmacologic strategy alone has been identified as an effective method of therapeutic intervention demonstrating pain relief and increased mobility related to patients with knee OA [1,4,5,9,10]. Additionally, local physical therapy, rehabilitation, and reduction of mechanical stress on joints may provide improvements in pain symptoms and maintain joint function, which mainly reflects the improvement in the quality of life of people affected by the disease [4]. ...
... However, cause-effect relationships between muscle weakness and OA are complex and have been widely debated [10]. Although the muscular strength probably decreases in people with OA as a secondary result of reduced activity, there is evidence that muscle weakness directly contributes to development and progression of OA [24]. ...
Article
Full-text available
Aim. Utilizing a cross-sectional case control design, the aim of this study was to evaluate the functional fitness and self-reported quality of life differences in older people diagnosed with knee osteoarthrosis (O) who participated in health promotion groups. Methods. Ninety older women were distributed into two groups: control without O of the knee (C, 𝑛 = 40) and a group diagnosed with primary and secondary kneeOwith grade II or higher, with definite osteophytes (OA,𝑛 = 50). Functional fitnesswas evaluated by specific tests, and the time spent in physical activity and quality of life was evaluated by the IPAQ andWHOQOL (distributed in four domains: physical: P, psychological: PS, social: S, and environmental: E) domain questionnaires. Results. No differences were found between ages of groups (C: 66 ± 7; OA: 67 ± 9; years).The values of the chair stand test (rep) in the OA (13 ± 5) group were different when compared to C group (22 ± 5). For the 6-minute walk test (meters), the values obtained for the C (635 ± 142) were higher (𝑃 < 0.01) than theOA (297 ± 143) group.The time spent in physical activity (min) was greater (𝑃 < 0.001) in the control (220 ± 12) group compared toOA(100 ± 10) group. Higher values (𝑃 < 0.001) in all domains were found in the C (P: 69 ± 16, PS: 72 ± 17, S: 67 ± 15, E: 70 ± 15) group compared to OA (P: 48 ± 7, PS: 43 ± 8, S: 53 ± 13, E: 47 ± 14) group. Conclusion. Our data suggests that knee O, in older women, can promote a decline in time spent performing physical activity and functional fitness with decline in quality of life with an increase in sitting time.
... For patients with knee osteoarthritis, exercise is the most common and effective therapy for enhancing knee function and reducing pain; it is also more cost-effective than other types of medical interventions. However, its mechanism is not fully understood [2][3][4][5] . A proprioceptive exercise is based on the notion that when a patient performs balance-keeping exercises on unstable surfaces, proprioception responses occur first among those generated by the somatic senses. ...
... Patients with degenerative knee osteoarthritis show reduced quadriceps strength and a decline in proprioception and balance 2,3) . Reduced proprioception in patients with osteoarthritis weakens their thigh muscle strength and could limit their walking ability and dynamic balance 11) . ...
Article
Full-text available
[Purpose] This study applied proprioceptive circuit exercise to patients with degenerative knee osteoarthritis and examined its effects on knee joint muscle function and the level of pain. [Subjects] In this study, 14 patients with knee osteoarthritis in two groups, a proprioceptive circuit exercise group (n = 7) and control group (n = 7), were examined. [Methods] IsoMed 2000 (D&R Ferstl GmbH, Hemau, Germany) was used to assess knee joint muscle function, and a Visual Analog Scale was used to measure pain level. [Results] In the proprioceptive circuit exercise group, knee joint muscle function and pain levels improved significantly, whereas in the control group, no significant improvement was observed. [Conclusion] A proprioceptive circuit exercise may be an effective way to strengthen knee joint muscle function and reduce pain in patients with knee osteoarthritis.
... However when comparing rehabilitation programs, there is little evidence for outcomes that are related to changes in muscle strength, which can be defined as the ability of muscle to exert force 16 , or indicators of muscle strength (e.g., muscle size). A single systematic review involving meta-analysis 17 that compared various rehabilitation programs in a population with knee and/or hip OA identified improvements in knee extension strength in favour of resistance exercise when compared to alternative interventions. However, the combination of the 'alternate intervention' group with control group data potentially dilutes the influence of the alternative intervention and inflates the effect size of the resistance programs. ...
... Similar results for functional outcomes were reported in a systematic review by Roddy et al. 77 when comparing aerobic exercise with strengthening exercises in people with knee OA. In contrast, the review by Latham et al. 17 identified improvements in knee extension strength in favour of resistance exercise when compared to alternative interventions. However as identified previously, the dilution of the "alternative intervention" group with control group data could have lead to the conflicting results in this review. ...
Article
Full-text available
Objective: To determine the effect of exercise-based rehabilitation programs on hip and knee muscle function and size in people with hip osteoarthritis. Methods: Seven databases were systematically searched in order to identify studies that assessed muscle function (strength or power) and size in people with hip osteoarthritis after exercise-based rehabilitation programs. Studies were screened for eligibility and assessed for quality of evidence using the GRADE approach. Data were pooled, and meta-analyses was completed on 7 of the 11 included studies. Results: Six studies reported hip and/or knee function outcomes, and two reported muscle volumes that could be included in meta-analyses. Meta-analyses were conducted for four strength measures (hip abduction, hip extension, hip flexion, and knee extension) and muscle size (quadriceps femoris volume). For hip abduction, there was a low certainty of evidence with a small important effect (effect size = 0.28, 95% CI = 0.01, 0.54) favouring high-intensity resistance interventions compared to control. There were no other comparisons or overall meta-analyses that identified benefits for hip or knee muscle function or size. Conclusion: High-intensity resistance programs may increase hip abduction strength slightly when compared with a control group. No differences were identified in muscle function or size when comparing a high versus a low intensity group. It is unclear whether strength improvements identified in this review are associated with hypertrophy or other neuromuscular factors.
... 1,12,[21][22][23][24][25][26][27][28] ST in women with KOA controls hypotrophy and moderates the progression of the joint disease. 1,[42][43][44][47][48][49][50] However, one cannot find studies evaluating the impacts of VIS and ST in conjunction, in the FC and in the QL of patients with KOA. In this study, it was measured the influence of viscosupplementation and strength training, in the quality of life and in the functional capacity of women with osteoarthritis of the knees level II and III. ...
... On the other hand, the hypothesis that the association of interventions would be more efficient than the use of one of them alone was not confirmed. However, it was shown that strength training, for its known beneficial effect in the joint mechanic [24][25][26][27][28][42][43][44][47][48][49][50] and anti inflammatory action 45 was, in isolation or in association, superior to viscosupplementation isolated suggesting a positive effect in the isokinetic response, reducing pain severity, and improving quality of life and functional capacity. ...
Article
Full-text available
The viscosupplementation and strength training are interventions accepted in the treatment of knee osteoarthritis. Objective: The study describes the effect of two interventions in quality of life and functional capacity. Method: Thirty women diagnosed with bilateral knee osteoarthritis of grade II and III by radiological criteria of Kellgren & Lawrence, were randomized into three groups with ten patients each: VSTF group submitted to viscosupplementation and strength training, TF group submitted only to strength training and VS group submitted only to viscossuplementation. Moments of the study were defined as pre-procedure (PRE), after 48 hours of VS (POS-VS) after 12 weeks of training (POS T) and after eight weeks of detraining (POS D). Quality of life was assessed by the SF-36 BRAZIL, functional capacity by Lequesne index. Intraarticular infiltrations were carried out with a single dose of 6 ml / 48 mg with 6,000,000 kDa Hylan GF-20 and strength training sessions were held for twelve weeks. Results: Strength training and viscosupplementation were effective in the treatment of knee osteoarthritis. Both interventions promoted improvements in quality of life and in functional capacity (p < 0.001), with advantage to the groups that trained force. Conclusion: Strength training is a possible replacement of viscosupplementation in the treatment of osteoarthritis of women's knees. However, the beneficial effect of viscosupplementation in pain reduction suggests better efficiency in the strength training execution which may be an advantage of the association of both.
... Meta-analysis of 8 randomized controlled trials in older adults (mean group age >65 years) found a moderate treatment effect on patients performing lower limb progressive resistance training (PRT) programs [17]. The moderate treatment effect was found for both lower limb strength and pain (SMD 5 0.33 and À0.35, respectively). ...
... Analyzing studies for osteoarthritis of the hip, the literature was much more sparse, with only two studies showing that resistance exercise decreases pain, while one study showed no effect of exercise on disability [63]. More recent systematic reviews with meta-analyses confirmed the benefits of resistance training for patients with osteoarthritis [64][65][66]. One of these meta-analyses showed that progressive resistance training, when compared with nonresistance training control groups, has moderate effect sizes for reducing pain ( Despite the large number of studies demonstrating the positive effects of resistance training on pain and functional capacity of patients with osteoarthritis, little is known about its effect on the progression of the disease. ...
Article
Full-text available
The aging process is characterized by several physiological, morphological, and psychological alterations that result in a decreased functional and health status throughout the life span. Among these alterations, the loss of muscle mass and strength (sarcopenia) is receiving increased attention because of its association with innumerous age-related disorders, including (but not limited to) osteoporosis, osteoarthritis, low back pain, risk of fall, and disability. Regular participation in resistance training programs can minimize the musculoskeletal alterations that occur during aging, and may contribute to the health and well-being of the older population. Compelling evidence suggest that regular practice of resistance exercise may prevent and control the development of several musculoskeletal chronic diseases. Moreover, resistance training may also improve physical fitness, function, and independence in older people with musculoskeletal disorders, which may result in improved quality of the years lived. In summary, regular participation in resistance training programs plays an important role in aging and may be a preventive and therapeutic tool for several musculoskeletal disorders.
... Physical activity is based on the skeletal muscle activity (Rannou and Poiraudeau, 2010). Exercise therapy (Fransen and McConnell, 2009) can be effective in reducing the pain associated with osteoarthritis, improving physical function, and (Penninx et al., 2001;Latham and Liu, 2010) significantly reducing the risk of disability in osteoarthritis (Alghamdi et al., 2004). Notably, age does not appear to affect the benefits of exercise training (Nelson et al., 2014), and the improvements in joint function following training are similar in older and younger people. ...
Article
Full-text available
Osteoarthritis is a chronic degenerative musculoskeletal disease characterized by pathological changes in joint structures along with the incidence of which increases with age. Exercise is recommended for all clinical treatment guidelines of osteoarthritis, but the exact molecular mechanisms are still unknown. Irisin is a newly discovered myokine released mainly by skeletal muscle in recent years—a biologically active protein capable of being released into the bloodstream as an endocrine factor, the synthesis and secretion of which is specifically induced by exercise-induced muscle contraction. Although the discovery of irisin is relatively recent, its role in affecting bone density and cartilage homeostasis has been reported. Here, we review the production and structural characteristics of irisin and discuss the effects of the different types of exercise involved in the current study on irisin and the role of irisin in anti-aging. In addition, the role of irisin in the regulation of bone mineral density, bone metabolism, and its role in chondrocyte homeostasis and metabolism is reviewed. A series of studies on irisin have provided new insights into the mechanisms of exercise training in improving bone density, resisting cartilage degeneration, and maintaining the overall environmental homeostasis of the joint. These studies further contribute to the understanding of the role of exercise in the fight against osteoarthritis and will provide an important reference and aid in the development of the field of osteoarthritis prevention and treatment.
... It is generally believed that exercise can reduce joint pain and improve joint function. Latham and Liu suggest exercise can strengthen the quadriceps [12], which effectively reduces lower limb pain and improve joint function [13], and Bennell et al. believe the key to the treatment of OA is restoring joint function [14,15]. Iijima et al. studied moderate exercise can also prevent OA from causing joint tissue damage [16]. ...
Article
Full-text available
Background: The aim of the study is to compare the effects of exercise therapy with chondroitin sulfate (CS) therapy in an experimental model of osteoarthritis (OA). Methods: Twenty-one New Zealand rabbits were randomly divided into four groups: normal group (N group, n = 3); OA control group (C group, n = 6); OA plus medication group (CS group, n = 6); and OA plus exercise group (E group, n = 6). Four weeks after modeling, the rabbits were subjected to exercise (artificial, 30 min/time, 4 times/week) or medicated with CS (2% CS, 0.3 ml/time, once/week) for 4 weeks. Histopathological changes in treated joints were examined after staining. X-ray and scanning electron microscopy was used to evaluate the different therapies by examining the surfaces and joint spaces of the articular cartilage. RT-qPCR was used to assess chondrogenic gene expression including Col2, Col10, mmp-13, il-1β, adamats-5, and acan in the experimental groups. Results: Histology showed both treatment groups resulted in cartilage that was in good condition, with increased numbers of chondrocytes, and the results of X-ray and scanning electron microscopy showed the therapeutic effect of exercise therapy is equivalent to CS therapy, surface articular cartilage was flat, and the of cartilage layer was thinning. All treated groups induced the expression of Col10 and Col2 and decreased expression of mmp-13, il-1β, and adamats-5 compared with the control groups. The expression of acan was upregulated in the E group and downregulated in the CS group. Furthermore, expression of Col10 was higher and il-1β was lower in the exercise group compared to that of the CS group. Conclusion: These results indicate that exercise has a positive effect on OA compare with CS, and it also supplies reference for the movement mode to improve function.
... 4 Resistance training is beneficial to geriatric individuals because weight lifting can help counter the typical issues that surface as adults age; such as decreased range of motion, reduced strength, and a lack of stability. Resistive training has the ability to improve function, reduce pain, and increase strength in people with osteoarthritis Latham et al. 5 Women over the age of 80years old have shown a 40% reduced chance of falling after engaging in strength and balance exercises CDC. 6 ...
... In previous studies, no adverse events were observed during the exercise interventions. However, despite the lack of adverse events, attention should be paid to patient-reported back or knee pain or any muscu- loskeletal injuries, as well as the elderly response to exercise training (e.g., strength training; Latham & Liu, 2010). ...
Article
Full-text available
Background Frailty syndrome is now becoming a challenge for multidisciplinary teams. Frailty assessment in elderly patients is recommended due to the associated cascade of irreversible alterations that ultimately result in disability. Aims The purpose of this article is to identify interventions, which can be implemented and performed by nurses as part of a multidisciplinary plan. Nursing strategies related to nutrition, polypharmacy, adherence to treatment, falls, exercise, and mood and cognitive intervention are described. Design Discussion paper. Data sources Relevant and up-to-date literature from PubMed, MEDLINE, and Scopus databases regarding the selected issues, such as nutritional status, polypharmacy, falls, physical activity, and cognitive functions. Conclusion Frailty is considered preventable or even reversible with the appropriate interventions, which can help maintain or even restore physical abilities, cognitive function, or nutritional status in frail elderly patients. Hence, the nursing interventions are significant in clinical practice and should be implemented for frail patients. Implications for nursing Health-care providers, especially nurses, in their clinical practice should recognize not only elderly patients but also elderly patients with concurrent frailty, requiring intensified therapeutic interventions tailored to their individual needs. Frailty syndrome is undoubtedly a challenge for multidisciplinary teams providing health care for geriatric patients.
... 13 These unanswered questions may be one of the reasons why we see a large variation in treatment effects observed across studies making it difficult to conclude what is the optimal dose when delivering exercise therapy. 12 13 The exercises vary from neuromuscular exercise, 14 knee joint stabilisation exercises, 15 strengthening exercises 16 and endurance exercises. 17 These forms of exercise therapy do not necessarily take into consideration the theories of local and central sensitisation, thus opening up avenues for exercise therapies where the goal is modulation of pain, decreasing local and central sensitisations. ...
Article
Full-text available
Introduction: Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA. Methods and analysis: This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment. Ethics and dissemination: This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences. Trial registration number: NCT02024126; Pre-results.
... [46][47][48] Systematic reviews have provided meta-analyses examining the effectiveness of exercise as a treatment for OA. Given the large number of these reviews [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] and the overall consensus that exercise reduces pain and disability, a review of these reports is provided here. Only reviews examining randomized controlled trials and performing meta-analysis were included. ...
Article
Osteoarthritis (OA) is a disorder involving deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. The incidence of OA in the military increased over the period 2000 to 2012 and was the first or second leading cause of medical separations in this period. Risk factors for OA include older age, black race, genetics, higher body mass index, prior knee injury, and excessive joint loading. Animal studies indicate that moderate exercise can assist in maintaining normal cartilage, and individuals performing moderate levels of exercise show little evidence of OA. There is considerable evidence that among individuals who develop OA, moderate and regular exercise can reduce pain and disability. There is no firm evidence that any particular mode of exercise (e.g., aerobic training, resistance exercise) is more effective than another for reducing OA-related pain and disability, but limited research suggests that exercise should be lifelong and conducted at least three times per week for optimal effects.
... Within this framework, there exists more specific goals of quadriceps muscle strengthening, joint stabilization, maintaining range of motion, and improving aerobic exercise capacity. 12,13 Patients and providers alike are sometimes apprehensive about the potential for exercise to precipitate further harm to the joints. However, there is limited evidence to suggest that physical activity causes or exacerbates symptomatic knee OA. ...
Article
The goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.
... 11 There is considerable evidence that once an individual develops OA, moderate and regular exercise of many types (e.g., aerobic exercise, resistance training, flexibility training) can reduce pain and disability. [12][13][14][15][16][17][18][19][20][21] Limited research suggests that exercise is most effective if conducted at least three times per week, but there is no firm evidence that any particular type of exercise is more effective than another form. 17,18,22 It has been suggested that glucosamine may reduce OA-related pain and slow the progression of this disease. ...
Article
Full-text available
BACKGROUND: Osteoarthritis (OA) is a disorder involving deterioration of articular cartilage and underlying bone and is associated with symptoms of pain and disability. Glucosamine is a component of articular cartilage naturally synthesized in the body from glucose and incorporated into substances contained in the cartilage. It has been suggested that consumption of glucosamine may reduce the pain of OA and may have favorable effects on structural changes in the cartilage. This article presents a systematic review and meta-analysis of the effectiveness of orally consumed glucosamine sulfate (GS) on OA-related pain and joint structural changes. METHODS: PubMed and Ovid Embase were searched using specific search terms to find randomized, double-blinded, placebo-controlled trials on the effects of GS on pain and/or joint-space narrowing. The outcome measure was the standardized mean difference (SMD), which was the improvement in the placebo groups minus the improvement in the GS groups divided by the pooled standard deviation. RESULTS: There were 17 studies meeting the review criteria for pain, and the summary SMD was -0.35, with a 95% confidence interval (95% CI) = -0.54 to -0.16 (negative SMD is in favor of GS). Of the 17 studies, 7 showed a statistically significant reduction in pain from GS use. Four studies met the review criteria for joint space narrowing with a summary SMD = -0.10 (95% CI = -0.23 to +0.04). Studies without involvement of the commercial glucosamine industry had a lower (but still significant) pain reduction efficacy (summary SMD = -0.19, 95% CI = -0.39 to -0.02) than those with industry involvement. Several smaller dosages throughout the day had larger pain reduction effects than a single daily large dose (1500 mg). CONCLUSION: These data indicate that GS may have a small to moderate effect in reducing OA-related pain but little effect on joint-space narrowing. Until there is more definitive evidence, healthcare providers should be cautious in recommending use of GS to their patients. Because GS dosages used in studies to date resulted in mild and transient adverse effects, and these were similar to that experienced by patients receiving placebos, larger GS doses possibly could be investigated in future studies. 2018.
... These findings are similar to those of previous studies and revealed the short-term and long-term (2-6 months) benefits of exercise for improving pain, physical functions, and quality of life for people with knee osteoarthritis. [18,19,25,28,33,56,57]. However, the results revealed that the 30-s chair stand and 10-m walk tests revealed no significant improvement in the CRE group compared with the CON group. ...
Article
Full-text available
Background Osteoarthritis (OA) is common in aged adults and can result in muscle weakness and function limitations in lower limbs. Knee OA affects the quality of life in the elderly. Technology-supported feedback to achieve lower impact on knee joints and individualized exercise could benefit elderly patients with knee OA. Herein, a computer-aided feedback rowing exercise system is proposed, and its effects on improving muscle strength, health conditions, and knee functions of older adults with mild knee OA were investigated. Methods Thirty-eight older adults with mild knee OA and satisfying the American College of Rheumatology (ACR) clinical criteria participated in this randomized controlled clinical trial. Each subject was randomly assigned to a computer-aided rowing exercise (CRE) group (n = 20) or a control group (CON) (n = 18) that received regular resistance exercise programs two times per week for 12 weeks. Outcome measurements, including the Western Ontario and MacMaster Universities (WOMAC), muscle strength and functional fitness of the lower limbs, were evaluated before and after the intervention. Results Participants’ functional fitness in the CRE group exhibited significantly higher adjusted mean post-tests scores, including the WOMAC (p = 0.006), hip abductors strength (kg) (MD = 2.36 [1.28, 3.44], p = 5.67 × 10–5), hip adductors strength (MD = 3.04 [1.38, 4.69], p = 0.001), hip flexors strength (MD = 4.01 [2.24, 5.78], p = 6.46 × 10⁻⁵), hip extensors strength (MD = 2.88 [1.64, 4.12], p = 4.43 × 10⁻⁵), knee flexors strength (MD = 2.03 [0.66, 3.41], p = 0.005), knee extensors strength (MD = 1.80 [0.65, 2.94], p = 0.003), and functional-reach (cm) (MD = 3.74 [0.68, 6.80], p = 0.018), with large effect sizes (η² = 0.17–0.42), than those in the CON group after the intervention. Conclusions Older adults with knee OA in the CRE group exhibited superior muscle strength, health conditions, and functional fitness improvements after the 12-week computer-aided rowing exercise program than those receiving the conventional exercise approach. Trial registration The Institutional Review Board of the Taipei Medical University approved the study protocol (no. N201908020, 27/05/2020) and retrospectively registered at ClinicalTrials.gov (trial registry no. NCT04919486, 09/06/2021).
... If we look at ameliorating pain, there is strong clinical evidence that physical exercise plays an important role in mitigating pain levels in patients with knee or hip osteoarthritis [33]. In particular, resistance training is beneficial in reducing pain, improving proprioception, and enhancing older osteoarthritic adults' abilities to perform activities of daily living [34]. Resistance training contributes to the maintenance of functional abilities, preventing older adults from developing sarcopenia, falls, fractures, disabilities, and persistent pain [35]. ...
Article
Objective: In older adults, the impact of persistent pain goes beyond simple discomfort, often contributing to worsening functional outcomes and ultimately frailty. Frailty is a geriatric syndrome that, like persistent pain, increases in prevalence with age and is characterized by a decreased ability to adapt to common stressors such as acute illness, thereby increasing risk for multiple adverse health outcomes. Evidence supports a relationship between persistent pain and both the incidence and progression of frailty, independent of health, social, and lifestyle confounders. Design and setting: In this article, we synthesize recent evidence linking persistent pain and frailty in an effort to clarify the nature of the relationship between these two commonly occurring geriatric syndromes. Setting: We propose an integration of the frailty phenotype model by considering the impact of persistent pain on vulnerability toward external stressors, which can ultimately contribute to frailty in older adults. Results and conclusions: Incorporating persistent pain into the frailty construct can help us better understand frailty and ultimately improve care for patients with, as well as those at increased risk for, pain and frailty.
... As muscle weakness of the lower extremity is very common in individuals with knee OA, strength training has become the cornerstone of exercise therapy in the treatment of OA (Roos et al., 2011;Thorlund et al., 2012). Strong supporting evidence has shown that strength training can benefit individuals with OA in terms of reduced pain and improved physical function (Latham and Liu, 2010). ...
Article
Full-text available
Osteoarthritis (OA) is a leading cause of disability in elderly individuals. As a common chronic degenerative joint disease, OA is typically characterized by articular cartilage degeneration, subchondral bone sclerosis, and concomitant synovium inflammation. As such, the structural and functional alterations in the articular cartilage and subchondral bone become the focus of research during progression of OA. Similarly, the molecular mechanism regulating articular cartilage lubrication and the cellular communication controlling metabolic status of subchondral bone cells promote innovative strategies for prevention and treatment of early stage OA. The current therapeutic options for OA are aimed at keeping the associated pain, inflammation, and degeneration of synovial joint tissues manageable in order to minimize the structural and symptomatic progression. These include, but are not limited to, synergetic therapy combining lubrication and drug intervention, regulatory balance between bone resorption and formation, and exercise therapy. In this mini review, we focus on the up-to-date research progress on these novel strategies for OA treatment.
... 8,9 Other systematic reviews that compare exercise with or without manual therapy to all no-exercise controls found very low quality evidence that exercise was beneficial for pain. [10][11][12] Resistance exercise has previously been shown to be of benefit for knee osteoarthritis, 13 back pain 14 and is a widely used and recommended treatment modality. 15,16 Resistance exercise includes movement against body weight, gravity or by adding load with weight or elastic resistance band (Theraband). ...
Article
Objective Synthesize evidence regarding effectiveness of progressive and resisted or non-progressive and non-resisted exercise compared with placebo or no treatment, in rotator cuff related pain. Data sources English articles, searched in Cochrane CENTRAL, MEDLINE, EMBASE and CINAHL databases up until May 19, 2020. Methods Randomized controlled trials in people with rotator cuff related pain comparing either progressive and resisted exercise or non-progressive and non-resisted exercise, with placebo or no treatment were included. Data extracted independently by two authors. Risk of bias appraised with the Cochrane Collaboration tool. Results Seven trials (468 participants) were included, four trials (271 participants) included progressive and resisted exercise and three trials (197 participants) included non-progressive or non-resisted exercise. There was uncertain clinical benefit for composite pain and function (15 point difference, 95% CI 9 to 21, 100-point scale) and pain outcomes at >6 weeks to 6 months with progressive and resisted exercise compared to placebo or no treatment (comparison 1). For non-progressive or non-resisted exercise there was no significant benefit for composite pain and function (4 point difference, 95% CI −2 to 9, 100-point scale) and pain outcomes at >6 weeks to 6 months compared to placebo or no treatment (comparison 2). Adverse events were seldom reported and mild. Conclusions There is uncertain clinical benefit for all outcomes with progressive and resisted exercise and no significant benefit with non-progressive and non-resisted exercise, versus no treatment or placebo at >6 weeks to 6 months. Findings are low certainty and should be interpreted with caution.
... Available evidence suggests a small to moderate effect of exercise as compared with not exercising for hip or knee OA [8,9]. Clinical studies have shown that aerobic physical activity and muscle-strengthening exercise may help reduce OA symptoms and improve joint function [10]. The modalities of exercise are numerous (Table 1) [11] and should be adjusted to the affected joint and to the comorbidities. ...
Article
Full-text available
Background. Rehabilitation is widely recommended in national and international guidelines for the management of osteoarthritis (OA) in primary care settings. According to 2014 OA Research Society International (OARSI), rehabilitation is even considered as the core treatment of OA, and is recommended for all individuals. Rehabilitation for OA widely includes land- and water-based exercise, strength training, weight management, self-management and education, biomechanical interventions, and physically active lifestyle. Objectives. To review the efficacy and safety of rehabilitation in the management of OA, and to discuss evidence-based international recommendations. Methods. A critical narrative review was conducted. The process of article selection was unsystematic. Articles included were selected based upon authors’ expertise, self-knowledge, and reflective practice. For the purpose of the review, we focused on land- and water-based exercise, and strength training for knee, hip and hand OA. Other aspects of rehabilitation in OA are treated elsewhere in this special issue. Results. Exercise therapy is widely recommended in the management of knee, hip and hand OA. However the level of evidence varies according to OA location. Overall, consistent evidence suggests that exercise therapy and specific strengthening exercise or strength training for the lower limb reduce pain and improve physical function in knee OA. Evidence for other OA sites are less consistent. Therefore recommendations for hip and hand OA, due to the lack of specific studies, mainly derived from studies performed in knee OA. In addition, no recommendations have been established regarding the exercise regimen. Discussion and conclusions. The efficacy and safety of exercise therapy and strength training need to be further evaluated in randomized controlled trials in patients with hip and hand OA. The optimal delivery of exercise programs also has to be more clearly defined.
... According to a United Nations report [1], more than 40% of the population of Taiwan is expected to be aged 60 years or older by 2050, which would make Taiwan one of the top ten super-aged societies worldwide. As part of the aging process, older people experience a loss of muscle strength and mass [2], which makes them vulnerable to physical function decline [3]. Therefore, one of the key goals of superaged societies is maintaining or improving their aging population's physical functional abilities in order to prevent disability and increase their overall capacity for independent living [4]. ...
Preprint
Full-text available
Background: Evidence regarding the association between daily steps recommendation and older adults’ lower limb strength is lacking; thus, this study investigated whether taking at least 7,000 steps/day is cross-sectionally and prospectively related to lower-extremity performance in older Taiwanese adults. 89 community-dwelling adults aged over 60 years (mean age: 69.5 years) who attended both baseline and follow-up surveys. Methods: This study used adjusted logistic regression analysis to explore cross-sectional and prospective relationships between their accelerometer-assessed daily steps and lower-extremity performance (five-times-sit-to-stand test). Results: This study found the older adults who took 7,000 steps/day were more likely to have better lower-extremity performance cross-sectionally (odds ratio [OR] = 3.82; 95% confidence interval [CI]: 1.04, 13.95; p = 0.04), as well as to maintain or increase their lower-extremity performance prospectively (OR=3.53; 95% CI: 1.05, 11.84; p = 0.04). Conclusions: Our findings support a minimum recommended level of step-based physical activity for older adults, namely, 7,000 steps/day, as beneficial for maintaining or increasing older adults’ lower-extremity performance.
... 61 Importantly, the presence of pain does not appear to prevent strength gains, as studies have demonstrated that resistance exercises can increase strength in older adults suffering from clinical pain conditions. 62,63 The relationship between pain and disability also appears to be weaker in older than in younger adults, and may, therefore, interfere less with functional performance gains. 64 Increased self-efficacy, the perceived ability to manage their condition, has also been associated with better gait performance in older persons with knee osteoarthritis. ...
Article
Full-text available
Purpose: Older adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program. Patients and methods: A retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant. Results: The TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= -0.16 to 0.15, all p-values >0.10). Conclusion: These results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.
... La dosis de AF o ejercicio se describe por la duración, frecuencia, intensidad y modo (Latham y Liu, 2010). Para obtener efectos óptimos, la persona o adulto mayor debe cumplir con el programa de ejercicio prescrito y seguir el principio de sobrecarga del entrenamiento, es decir, hacer ejercicio cerca del límite de la capacidad máxima para desafiar los sistemas del cuerpo lo suficiente, para inducir mejoras en los parámetros fisiológicos como VO2max y fuerza muscular (Taylor, 2014). ...
Article
Full-text available
El brote epidémico SARS–CoV–2 se ha convertido en una pandemia por la enfermedad COVID19, para contener de una manera más eficaz la enfermedad es fundamental establecer un período de cuarentena óptimo para que aproximadamente el 95% de los casos sean retenidos y reducir el riesgo de transmisión. El estudio tiene como objetivo, analizar la actividad física, alimentaria y psicológica emergente del estatus QUO en los adultos mayores del CEAM la Delicia-Ecuador, en estado de cuarentena Covid19. Se aplicó una metodología mixta de diseño exploratorio secuencial, para la recolección de datos se ejecutó un análisis teórico documental y un cuestionario de opción múltiple. Los datos fueron analizados a través de la triangulación o contrastación de información. Los resultados demuestran que el sedentarismo induce a que los adultos mayores disipen sus niveles funcionales de forma acelerada. El estrés y miedo psicológico se relaciona con la estabilidad sedentaria que se establece por la cuarentena, provocando insurrecciones en el sueño, generando ansias de digerir alimentos. Los investigadores recomiendan una alimentación sana en fibras y vitaminas, y promover el ejercicio en la población de edad avanzada, ya que esta situación se considera un problema clínico y de salud pública.
... According to studies, there is a direct relationship between the reduced range of joints motion and falling [12]. Moreover, this decreased range in the lower limb elevates the risk of falls, by affecting the dynamic of this limb while walking [13]. These changes due to the aging process are associated with physical dysfunction and a decrease in health status [14]. ...
Article
Introduction: The present study aimed to investigate the effects of 6 weeks of Dynamic Neuromuscular Stability (DNS) training on performance (lower limb strength, flexibility, fall risk) and quality of life in the elderly. Materials and Methods: This was a quasi-experimental study with a pretest-posttest design. This research was performed on 30 elderly males, aged 60-70 years in Qom Province, Iran in 2021. The examined elderly were randomly divided into the experimental and control groups (n=15/group). Furthermore, the experimental group participated in three 45-minute weekly sessions of DNS training for 6 weeks. To collect the necessary information before and after applying the training protocol, tint tests, 30-second seat sitting test, sitting and delivery test, TUG test, and SF-36 questionnaire were used. The obtained data were analyzed using Analysis of Covariance (ANCOVA) and Paired Samples t-test at a significance level of 0.05. Results: The ANCOVA results indicated a significant difference between the experimental and control groups in motor function, fall risk, quality of life, lower limb strength, and flexibility (P<0.05). The collected mean scores outlined that the experimental group performed better than the control group. Conclusion: Due to the effectiveness of DNS training on physical function and the very high importance of the elderly lifestyle, it is recommended that the provided training protocol be used for prevention and rehabilitation, increase the level of physical fitness and quality of life as a low-cost treatment, among the elderly.
... In addition to weak muscle strength, obesity which is suggested to be secondary to inactivity, is well-established to favor the development of knee OA through increased leverage, whereby the risk of knee OA is reported to increase by 36% with every 2 units of body mass index (BMI) gained, and the likelihood of developing knee OA by 4.2x in individuals with a BMI >30 kg/m 2 (15,16). Hence, it was recommended that patients with OA increase the amount of exercise they do, such as weight lifting and strength training to increase muscle strength, as this has been proven to reduce pain and improve physical function, as well as aid in weight-loss (17)(18)(19)(20). However, the pain and physical restrictions that come with OA often act as hurdles that keep OA patients from implementing and sustaining such activities. ...
Article
Full-text available
Osteoarthritis (OA) is a degenerative disorder of the cartilage and is one of the leading causes of disability, particularly amongst the elderly, wherein patients with advanced-stage OA experience chronic pain and functional impairment of the limbs, thus resulting in a significantly reduced quality of life. The currently available treatments primarily revolve around symptom management, and is thus palliative rather than curative. The aim of the present review is to briefly discuss the limitations of some of the currently available treatments for patients with OA, and highlight the value of the potential use of stem cells in cellular therapy, which is widely regarded as the breakthrough that can address the present unmet medical needs for treatment of degenerative diseases, such as OA. The advantages of stem cell therapy, particularly mesenchymal stem cells, and the challenges involved are also discussed in this review.
... According to a United Nations report, more than 40 % of the population of Taiwan is expected to be aged 60 years or older by 2050, which would make Taiwan one of the top ten super-aged societies worldwide [1]. As part of the aging process, older people experience a loss of muscle strength and mass [2], which makes them vulnerable to physical function decline [3]. Therefore, one of the key goals of a super-aged society is maintaining or improving the physical functional abilities of the aging population in order to prevent disability and increase their overall capacity for independent living [4]. ...
Article
Full-text available
Background Evidence regarding the association between daily steps recommendation and older adults’ lower limb strength is lacking; thus, this study investigated whether taking at least 7,000 steps/day is cross-sectionally and prospectively related to lower-extremity performance in older Taiwanese adults. Methods There were 89 community-dwelling adults aged over 60 years (mean age: 69.5 years) attending both baseline and follow-up surveys. This study used adjusted logistic regression analysis to explore cross-sectional and prospective relationships between their accelerometer-assessed daily steps and lower-extremity performance (five-times-sit-to-stand test). Results This study found the older adults who took 7,000 steps/day were more likely to have better lower-extremity performance cross-sectionally (odds ratio [OR] = 3.82; 95 % confidence interval [CI]: 1.04, 13.95; p = 0.04), as well as to maintain or increase their lower-extremity performance prospectively (OR = 3.53; 95 % CI: 1.05, 11.84; p = 0.04). Conclusions Our findings support a minimum recommended level of step-based physical activity for older adults, namely, 7,000 steps/day, as beneficial for maintaining or increasing older adults’ lower-extremity performance.
... Training with low repetitions and high resistance favours adaptions for strength, power, and hypertrophy, whereas training with high repetitions and low resistance increases muscular endurance and appears more suitable for submaximal, prolonged contractions [62]. Given the concern that high-intensity or high-load strength training may increase pain and joint stress for those with osteoarthritis [63], in addition to the function and endurance deficits observed in the present study, endurance training may be the most suitable training modality in the hip osteoarthritis population. For example, research has shown benefits of indoor cycling classes [64] and circuit-based weight training for adults with hip osteoarthritis [65]. ...
Article
Purpose This study compares lower limb muscle strength and endurance in adults with hip osteoarthritis, to an age-matched control group. Methods Thirteen adults with moderate-to-severe hip osteoarthritis (as graded by the Oxford Hip Score) and fifteen older adults participated. Maximal voluntary isometric contraction of the knee extensors, knee flexors and hip abductors and isotonic endurance of the knee extensors were measured using a dynamometer. Function was assessed using the 30-second chair stand test, the 40 m fast-paced walk test and a stair negotiation test. Data were compared between groups using t-tests. Results Participants with hip osteoarthritis demonstrated weakness in the affected limb when compared to the control limb during knee flexion (34%, p = 0.004) and hip abduction (46%, p = 0.001). Weakness was also observed in the contralateral knee flexors (31%, p = 0.01). When compared to the control limb, the knee extensors of the hip osteoarthritis group were exhausted prematurely in the affected (70%, p = 0.001) and contralateral limb (62%, p = 0.005). The hip osteoarthritis group took twice as long to stair climb (p = 0.002), walked 40% slower, (p < 0.001), and had a 35% lower sit-stand performance (p < 0.001). Conclusions Moderate-to-severe hip osteoarthritis may be characterised by bilateral deficits in lower-limb maximal strength, markedly lower knee extensor endurance and impaired functional performance. • Implications for rehabilitation • In addition to bilateral deficits in maximal strength of the hip and knee muscles, moderate-to-severe hip osteoarthritis may be characterised by markedly lower muscular endurance of the knee extensors and impaired functional performance. • The endurance capacity of the knee extensors can play an important role in daily function, and thus it is important to consider endurance training principles when prescribing exercise for this patient group. • Research studies evaluating exercise programmes underpinned by endurance training principles are required to understand the benefits to patients with hip osteoarthritis, and to inform specific exercise prescription in clinical practice.
... resistance training, where the resistance is progressively increased to maintain relative intensity, can lead to significant improvements in older adults with knee OA 10 by ameliorating sarcopenic changes and by improving the strength and function of the surrounding connective tissue, which is often damaged by the disease. 10,11 The body of literature that evaluates muscle strengthening interventions on symptoms of knee OA, however, pays little or no attention to the principles of resistance training. Consideration of these principles ensures that the intervention is likely to elicit the desired outcome. ...
Article
Full-text available
Objective: To evaluate the methodological quality of resistance training interventions for the management of knee osteoarthritis. Data sources: A search of the literature for studies published up to 10(th) August 2015 was performed on Medline (OVID platform), PubMed, EMBase and PEDRo databases. Search terms associated with 'osteoarthritis'; 'knee' and 'muscle resistance exercise' were used.. Study selection: Studies were included in the review if they were published in the English language and met the following criteria : 1) muscle resistance training was the primary intervention; 2) RCT design; 3) treatment arms included at least a muscle conditioning intervention and a non-exercise control group; 4) participants had osteoarthritis of the knee; . Studies employing pre-operative (joint replacement) interventions with only post-operative outcomes were excluded. The search yielded 1574 results. The inclusion criteria were met by 34 studies. Data extraction: Two reviewers independently screened the papers for eligibility. Critical appraisal of the methodology was assessed according to the principles of resistance training (PoRT) and, separately for the reporting of adherence using a specially designed scoring system. A rating for each was assigned. Data synthesis: 34studies described a strength training focus of the intervention, however, the PoRT were inconsistently applied and inadequately reported across all. Methods for adherence monitoring were incorporated in to the design of 28 of the studies but only 13 reported sufficient detail to estimate average dose of exercise. Conclusions: These findings impact the interpretation of the efficacy of muscle resistance exercise in the management of knee osteoarthritis. Clinicians and health-care professionals cannot be confident whether non-significant findings are due to lack of efficacy of muscle resistance interventions, or occur through limitations in treatment prescription and patient adherence. Future research that seeks to evaluate the effects of muscle strength training interventions on symptoms of OA should be properly designed and adherence diligently reported.
Article
Background: Physical activity holds promise for mobility-impaired older adults to prevent further disabilities and improve their health. However, staffing constraints have made it challenging to promote physical activity in long-term care facilities. Objectives: To test the feasibility and effects of 12 months Wheelchair-bound Senior Elastic Band (WSEB) group-exercises that were led by volunteers for the first six months followed by the DVD-guided for another six months on functional fitness, activities of daily living (ADL), and sleep quality of nursing home older adults in wheelchairs. Design: Cluster randomized controlled trial with two groups, pre-test and post-tests. Settings: Ten nursing homes, Taiwan. Participants: 127 participants participated voluntarily; 107 of them completed the study. Inclusion criteria: (1) aged 65 years and over, (2) using wheelchairs for mobility, (3) living in facility for at least three months, (4) cognitively intact, and (5) heavy or moderate dependency in ADL. Majority of participants were middle-old older adults (75-84 years old, 53.2%), female (51.4%), and had chronic illnesses (98.1%). Methods: Participants were randomly assigned by facility to either the experimental (five nursing homes, n=56) or control group (five nursing homes, n=51). The WSEB program was conducted three times per week and 40min per session in two stages: volunteer-led for the first six months (stage I) followed by the DVD-guided modality for another six months (stage II). The primary outcomes (functional fitness: lung capacity, body flexibility, range of joint motion, and muscle strength and endurance) and the secondary outcomes (ADL measured by the Barthel Index; sleep quality measured by the Pittsburgh Sleep Quality Index) of the participants were measured at three time points: pre-test, at the six-month interval, and at the end of 12 months of the study. No blinding was applied. Results: All of the functional fitness indicators of the experimental group participants improved significantly (p<.05), and were all better than the control group at six-month and 12-month of the study (p<.05). No symptoms of discomfort occurred during interventions. Conclusions: Nursing home older adults in wheelchairs who received WSEB exercise training had better functional fitness, ADL, and sleep quality than those who did not. It was a feasible way of carrying out this exercise program by using the volunteer-led followed by the DVD-guided modalities. The program can be applied in institutional settings routinely.
Article
Osteoarthritis (OA) is a common problem in society and can lead to significant disability and impairment of a patient's capacity to perform activities of daily living. The focus of this article is various treatment options for the management of OA, with emphasis on conservative management. The emphasis is on the role of exercise, pharmacology, intra-articular joint injections, and bracing options in the management of OA.
Article
Background: Sleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes. Methods: One hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study. Discussion: Participants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study. Conclusions: Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities.
Article
The treatment strategies for osteoarthritis (OA) are well known from numerous studies. One of the challenges is long-term patient compliance to the recommended therapies without supervision. To examine the ability of salutogenic concepts to improve rehabilitative management of OA. Review article introducing salutogenic concepts and their empiric evidence, focussing on Antonovsky's sense of coherence (SOC). The SOC consists of the three components comprehensibility, manageability and meaningfulness. SOC can be quantified by SOC-13, a self-reported measurement with 13 items. Associations of the SOC with different dimensions of health (in particular with Short Form 36, SF-36) are known from cross-sectional studies. Most studies showed a stronger correlation of the mental than the physical health dimensions of SF-36 with SOC-13. This result is consistent with baseline examinations of hip and knee OA patients before rehabilitation. At the 6-month follow-up, correlations between SOC and the changes of the SF-36 scores were weak. A salutogenically orientated instruction for self-management of symptoms in cancer patients showed significant improvement in SOC. Increasing SOC can lead to health improvements on many levels, e.g. self-efficacy, reduction of fear, coping, education, resources and compliance to treatment. Empirical proof that interventional measures increasing SOC can improve the health of OA patients is currently unavailable.
Article
Full-text available
ZUSAMMENFASSUNG Hintergrund: Für den Erhalt der Mobilität und damit auch der Fähigkeit, sich im Alltag selbst zu versorgen, wird Krafttraining mit steigendem Alter zunehmend bedeutsam. Als Ziel des Trainings soll einer Abnahme von Muskelmas-se und motorischer Kompetenz entgegengewirkt werden. Allerdings ist derzeit nicht abschließend geklärt, welche Trainingseffekte abhängig von der Belastungsintensität er-reicht werden. Methoden: In der Datenbank PubMed wurde eine selektive Literaturrecherche durchgeführt. Dabei wurde nach relevan-ten Publikationen der letzten fünf Jahre zu Effekten, Effi-zienz und zu Dosis-Wirkungs-Beziehungen von Krafttrai-ning bei Älteren gesucht.
Article
Full-text available
Background and Aim: With the advancing of age knee osteoarthritis has become the common musculoskeletal condition among males and females, various treatment strategies have been applied to improve the patient symptoms therefore the aim of this study is to compare the effectiveness of low resistance versus high resistance exercises along with stretching exercises on pain, physical function, & walking time in knee osteoarthritis. Methodology: Considering the pre-assessment inclusion criteria, a total no of 170 participants were enrolled in the study and divided into 5 groups by random apportion. Group A received a high resistance exercise, group B received low resistance exercises, group C high resistance exercises and stretching exercises, group D low resistance exercises and stretching exercises and group E received only stretching exercises for 3 weeks. After that pain, function and walking time were reassessed. Study Design: Experimental study, randomized control trial. Results: The intergroup results were significant with a p-value of <0.001. We assumed that all 5 groups’ interventions in the current study show a clinically meaningful reduction in pain and enhanced the level of functional activities. Effects of various exercise training are the same in all groups. Therefore, no significant difference has been noted. Conclusion: The all 5 groups’ high resistance exercise along with stretching, low resistance exercise along with stretching, high resistance exercise, low resistance exercise, and stretching exercise reduced pain and improved functional activity in patients with knee osteoarthritis.
Article
Pain with movement is a common issue for older adults with osteoarthritis; however, there has been insufficient attention within populations at increased risk for disabling pain, such as African American older adults. Accordingly, using a mixed methods approach, the purpose of the current study is to describe the nature of chronic joint pain and movement and its impact on physical function in African American older adults with symptomatic osteoarthritis. The authors accrued a sample of 110 African American older adults who completed cross-sectional surveys; from this sample, the authors interviewed 18 participants. Findings suggest that patterns of movement are uniquely influenced by pain. Specifically, three dynamic themes emerged: The Impact of Pain on Movement; The Importance and Impact of Movement on Pain; and The Adaptation of Personal Behaviors to Minimize Pain With Movement. Function-focused nursing care rests on addressing challenges and opportunities that African American older adults face in maintaining healthy movement when managing osteoarthritis pain. [Research in Gerontological Nursing, xx(x), xx-xx.].
Chapter
The primary care provider can manage various aspects of care for the patient with chronic pain. This is a multidisciplinary approach. Management of chronic pain involves the coordination of care from various organ specialists, physical therapists, and behavioral health specialists. It also involves the psychosocial aspects of pain which the primary care provider can address. Goal settings, expectation setting, positive affect interventions can be done in the primary care setting. Identifying negative affects such as depression, catastrophizing, and solicitous relationships can also be done by the primary care provider. Lastly, the primary care provider can refer to various pain specialists which may recommend procedures to improve chronic pain. Pain management techniques and interventions can be summarized as the combination of three components: a stimulus that alters nerve function, a delivery method, and a nervous system target (i.e. brain, spinal cord, or peripheral nerve).
Preprint
Full-text available
Background: Evidence regarding the association between daily steps recommendation and older adults’ lower limb strength is lacking; thus, this study investigated whether taking at least 7,000 steps/day is cross-sectionally and prospectively related to lower-extremity performance in older Taiwanese adults. Methods: There were 89 community-dwelling adults aged over 60 years (mean age: 69.5 years) attending both baseline and follow-up surveys. This study used adjusted logistic regression analysis to explore cross-sectional and prospective relationships between their accelerometer-assessed daily steps and lower-extremity performance (five-times-sit-to-stand test). Results: This study found the older adults who took 7,000 steps/day were more likely to have better lower-extremity performance cross-sectionally (odds ratio [OR] = 3.82; 95% confidence interval [CI]: 1.04, 13.95; p = 0.04), as well as to maintain or increase their lower-extremity performance prospectively (OR=3.53; 95% CI: 1.05, 11.84; p = 0.04). Conclusions: Our findings support a minimum recommended level of step-based physical activity for older adults, namely, 7,000 steps/day, as beneficial for maintaining or increasing older adults’ lower-extremity performance.
Article
Objective Increased levels of pro-inflammatory cytokines are associated with the release of degradative enzymes leading to osteoarthritis (OA) development. Although physical exercise (PE) is generally recognized as beneficial for OA symptoms, excessive training workload and eccentric muscular exercise have increased OA risk. Here, we investigated the effects of excessive exercise workload and exercise type on systemic inflammation and knee joint OA. Methods Mice were divided into five groups: sedentary (SED), uphill training (TRU), downhill training (TRD), excessive uphill training (ETU), and excessive downhill training (ETD) for an eight-week training intervention protocol. Results ETD group had increased pro-inflammatory cytokines in serum, vastus lateralis (VL), and vastus medialis (VM) muscles, while ETU group mice had increased cytokine levels in the VL and VM. General knee joint OARSI scores were more significant in ETD group compared to TRU group. They were also more meaningful for the medial tibial plateau of ETD group compared to SED group. MMP-3 and cleaved Caspase-3 were higher in the ETD group than the SED and TRU group, while Adamts-5 was higher in the ETD group than the SED group. TRU group had increased PRG-4 levels compared to ETU and ETD group. ETD group had decreased total bone volume, trabecular bone volume, and cortical thickness compared to SED group. Conclusion Excessive downhill training induced a chronic pro-inflammatory state in mice and was associated with early signs of cartilage and bone degeneration that are clinical indicators of knee OA.
Article
Background and Purpose: Resistance training has been shown to improve strength, endurance, and function in healthy older adults. The purpose of this case series was to describe the outcomes of a rehabilitation program consisting of heavy resistance training in older adults for management of hip pain. Case Description: Two male patients, aged 69 and 71, with chronic hip pain, participated in a six-week progressive resistance training rehabilitation program at loads equivalent to 76–81% of their one repetition maximum. Outcomes were assessed at evaluation, three, and six weeks. Outcomes included the Lower Extremity Functional Scale, hip and lumbar mobility, and the Five Times Sit to Stand test. Outcomes: By six weeks, each patient reported 0/10 pain and demonstrated clinically important improvements on the LEFS. Both patients’ final scores on the Five Times Sit to Stand test fell below the 15 second value for being at risk for falls. Patient One increased his lifting capacity for the deadlift by 92%, and Patient Two by 56%. Both patients were able to deadlift >70% of their one repetition maximum by the conclusion of this report. Discussion: To our knowledge, this is the first report of the outcomes of utilizing heavy resistance training in elderly adults with hip pain in a rehabilitative setting. Both patients demonstrated clinically important improvements in pain, disability, global lower extremity strength, and function by the conclusion of six weeks duration. Further research is needed regarding the effectiveness of heavy resistance training for the treatment of elderly adults with musculoskeletal pain.
Chapter
Millions of older adults across the world receive regular home care services to enable them to continue living independently in the community and avoid requiring admission into residential aged care. Older adults receiving home care services frequently have multiple chronic conditions, be they physical, cognitive, or psychosocial and hence health and home services, both private and public funded, provide tailored support to assist them to complete daily living tasks. There is strong, established evidence that exercise, and more broadly physical activity, improves and maintains older adults’ cardiorespiratory fitness, bone strength, healthy body mass, cognitive function, strength, and balance; all aspects that are important for maintaining functional ability, physical mobility, health-related quality of life and preventing falls. This chapter provides an overview of the context of home care services and systems, particularly those in Australia, including short-term (e.g., reablement and restorative care) and long-term (ongoing home care) services available to assist and enable older adults to remain living independently in the community. Physical activity guidelines for older adults, including the recent World Health Organization recommendations (2020) are then summarized. Evidence regarding best practice for engagement in exercise and physical activity, including barriers and enablers to participation specifically for older adults receiving home care are reviewed. The increasing incidence of falls in this population is also discussed, particularly in the context of safety in the home. Finally, recommendations for clinicians and those prescribing exercise or physical activity to older adults receiving home care services are summarized. Advice for older adults receiving home care and their families about how they can become more physically active and maintain their functional independence and ability to live independently is also provided.
Article
Objective: To investigate the effect of long-term resistance exercise of hindlimb on mechanical hyperalgesia of bilateral masseter muscle in rats with or without occlusal interference. Methods: Six-teen male Sprague-Dawley rats (220-250 g) were randomly divided into four groups: the naive control group, naive exercise group, occlusal interference control group, and occlusal interference exercise group. The rats in occlusal interference groups (occlusal interference control group and occlusal interference exercise group) obtained occlusal interference with 0.4 mm-thick crowns bonded to the right maxillary first molars. The rats in exercise groups (naive exercise group and occlusal interference exercise group) performed squat-type resistance exercises for 30 minutes, once a day, 5 days/week, lasting for 14 weeks. Resistance exercise was recorded every day. Mechanical withdrawal thresholds of bilateral masseter muscle were tested per week by use of modified electronic von-frey anesthesiometer. The rats were weighed per week. After the 14-week exercise, the muscle strength of the hindlimb was tested with a grip strength meter. Muscle (gastrocnemius and soleus) weight of bilateral hindlimb and length of bilateral fibula of the rats were obtained. The muscle-mass/body-mass ratios and muscle-mass/fibula-length ratios were calculated. Results: Between the naive control group and naive exercise group, there was no significant difference in the mechanical withdrawal thresholds of bilateral masseter muscle for the 0-4 weeks (P>0.05). During the 5-14 weeks, the mechanical withdrawal thresholds of the rats in the naive exercise group were higher than those in the naive control group (P<0.05). Between the occlusal interference control group and occlusal interference exercise group, there was no significant difference in the mechanical withdrawal thresholds of bilateral masseter muscle for the 0-6 weeks (P>0.05). During the 7-14 weeks, the mechanical withdrawal thresholds of rats in the naive exercise group were higher than those in the occlusal interference control group (P<0.05). After the 14week exercise, the body mass of the rats in nonexercise group (the naive control group and occlusal interference control group) were larger than those in exercise group [(462±6) g vs. (418±14) g, P<0.05]. And the muscle strength of hindlimb of the rats in exercise group were bigger than those in non-exercise group [(6.75±0.13) N vs. (5.41±0.15) N, P<0.01]. Conclusion: long-term resistance exercise can increase mechanical withdrawal thresholds of the bilateral masseter muscle in rats with or without masseter muscle mechanical hyperalgesia.
Article
Full-text available
Muscle mass decreases with age, leading to “sarcopenia, ” or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993–1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample(n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13–24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia. Am J Epidemiol 1998; 147: 755–63.
Article
Full-text available
We investigated trends in disability among older Americans from 1988 through 2004 to test the hypothesis that more recent cohorts show increased burdens of disability. We used data from 2 National Health and Nutrition Examination Surveys (1988-1994 and 1999-2004) to assess time trends in basic activities of daily living, instrumental activities, mobility, and functional limitations for adults aged 60 years and older. We assessed whether changes could be explained by sociodemographic, body weight, or behavioral factors. With the exception of functional limitations, significant increases in each type of disability were seen over time among respondents aged 60 to 69 years, independent of sociodemographic characteristics, health status, relative weight, and health behaviors. Significantly greater increases occurred among non-Whites and persons who were obese or overweight (2 of the fastest-growing subgroups within this population). We detected no significant trends among respondents aged 70 to 79 years; in the oldest group (aged>or=80 years), time trends suggested lower prevalence of functional limitations among more recent cohorts. Our results have significant and sobering implications: older Americans face increased disability, and society faces increased costs to meet the health care needs of these disabled Americans.
Article
Full-text available
In order to study the effects of increasing age on the human skeletal muscle, cross-sections (15 micron) of autopsied whole vastus lateralis muscle from 43 previously physically healthy men between 15 and 83 years of age were prepared and examined. The data obtained on muscle area, total number, size, proportion and distribution of type 1 (slow-twitch) and type 2 (fast-twitch) fibers were analysed using multivariate regression. The results show that the ageing atrophy of this muscle begins around 25 years of age and thereafter accelerates. This is caused mainly by a loss of fibers, with no predominant effect on any fiber type, and to a lesser extent by a reduction in fiber size, mostly of type 2 fibers. The results also suggest the occurrence of several other age-related adaptive mechanisms which could influence fiber sizes and fiber number, as well as enzyme histochemical fiber characteristics.
Article
Full-text available
To evaluate the influences of radiographic severity, quadriceps strength, knee pain, age, and gender on functional ability in patients with osteoarthritis of the knee. Equal numbers of knee pain positive and negative respondents to a survey of registrants aged more than 55 years at a general practice were invited to attend for knee radiographs and quadriceps femoris isometric strength estimations. Disability was measured using the Stanford Health Assessment Questionnaire. Complete data were available on 70 men (mean age 72.7 years) and 89 women (mean age 68.1 years); 44% reported knee pain, 48% had radiographic features of osteoarthritis, and 32% reported some degree of disability. Significant correlations were observed between disability and radiographic score, quadriceps strength, and knee pain. Logistic regression analysis, however, showed significant independent contributions from quadriceps strength (odds ratio 0.84 kgF), knee pain (odds ratio 1.67), and age (odds ratio 1.06 per year) only; the radiographic score had no influence on the model. These results were not influenced by confining the analysis to the group with radiographic features of osteoarthritis. Quadriceps strength, knee pain, and age are more important determinants of functional impairment in elderly subjects than the severity of knee osteoarthritis as assessed radiographically. Strategies designed to optimise muscle strength may have the potential to reduce a vast burden of disability, dependency, and cost.
Article
Full-text available
The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis. To explore the relation between lower-extremity weakness and osteoarthritis of the knee. Cross-sectional prevalence study. Population-based, with recruitment by random-digit dialing. 462 volunteers 65 years of age or older. Radiographs of the knee were graded for the presence of osteoarthritis. Knee pain and function were assessed with the Western Ontario and McMaster Universities Arthritis Index, the strength of leg flexors and extensors was assessed with isokinetic dynamometry, and lower-extremity lean tissue mass was assessed with dual-energy x-ray absorptiometry. Among participants with osteoarthritis, quadriceps weakness, but not hamstring weakness, was common. The ratio of extensor strength to body weight was approximately 20% lower in those with than in those without radiographic osteoarthritis. Notably, among women with tibiofemoral osteoarthritis, extensor weakness was present in the absence of knee pain and was seen in participants with normal lower-extremity lean mass (extensor strength, 30.1 lb-ft for those with osteoarthritis and 34.8 lb-ft for those without osteoarthritis; P < 0.001). After adjustment for body weight, age, and sex, lesser quadriceps strength remained predictive of both radiographic and symptomatic osteoarthritis of the knee (odds ratio for prevalence of osteoarthritis per 10 lb-ft loss of strength, 0.8 [95% CI, 0.71 to 0.90] for radiographic osteoarthritis and 0.71 [CI, 0.51 to 0.87] for symptomatic osteoarthritis). Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.
Article
Full-text available
To assess age and gender differences in muscle strength, isometric, concentric (Con), and eccentric (Ecc) peak torque was measured in the knee extensors at a slow (0.52 rad/s) and fast (3.14 rad/s) velocity in 654 subjects (346 men and 308 women, aged 20-93 yr) from the Baltimore Longitudinal Study of Aging. Regression analysis revealed significant (P < 0.001) age-related reductions in Con and Ecc peak torque for men and women at both velocities, but no differences were observed between the gender groups or velocities. Age explained losses in Con better than Ecc peak torque, accounting for 30% (Con) vs. 19% (Ecc) of the variance in men and 28% (Con) vs. 11% (Ecc) in women. To assess age and gender differences in the ability to store and utilize elastic energy, the stretch-shortening cycle was determined in a subset of subjects (n = 47). The older women (mean age = 70 yr) showed a significantly greater enhancement in the stretch-shortening cycle, compared with men of similar age (P < 0.01) and compared with younger men and women (each P < 0.05). Both men and women showed significant declines in muscle quality for Con peak torque (P < 0.01), but no gender differences were observed. Only the men showed a significant decline in muscle quality (P < 0.001) for Ecc peak torque. Thus both men and women experience age-related losses in isometric, Con, and Ecc knee extensor peak torque; however, age accounted for less of the variance in Ecc peak torque in women, and women tend to better preserve muscle quality with age for Ecc peak torque. In addition, older women have an enhanced capacity to store and utilize elastic energy compared with similarly aged men as well as with younger women and men.
Article
Full-text available
Understanding interrelationships among disablement concepts is critical to the design of future disability treatment and prevention interventions. This study uses cross-sectional data to examine the relationships among physiologic impairments, functional limitations, and disability in a moderately disabled sample of 207 community-dwelling older adults. As hypothesized, the data revealed statistically significant curvilinear relationships of upper and lower extremity strength and balance with mobility in this older sample. Multivariate analyses further clarified the hypothesized causal mechanism among the disablement concepts by demonstrating that most of the association of muscle strength and balance with disability was through the intermediary role of mobility limitations. The findings from this study highlight the value of clinical trials that focus on prevention or treatment of mobility limitations as a means of preventing disability; our findings underscore the need for future research that examines the effects of other variables believed to influence disablement in late life.
Article
Full-text available
The longitudinal changes in isokinetic strength of knee and elbow extensors and flexors, muscle mass, physical activity, and health were examined in 120 subjects initially 46 to 78 years old. Sixty-eight women and 52 men were reexamined after 9.7 ± 1.1 years. The rates of decline in isokinetic strength averaged 14% per decade for knee extensors and 16% per decade for knee flexors in men and women. Women demonstrated slower rates of decline in elbow extensors and flexors (2% per decade) than men (12% per decade). Older subjects demonstrated a greater rate of decline in strength. In men, longitudinal rates of decline of leg muscle strength were ∼60% greater than estimates from a cross-sectional analysis in the same population. The change in leg strength was directly related to the change in muscle mass in both men and women, and it was inversely related to the change in medication use in men. Physical activity declined yet was not directly associated with strength changes. Although muscle mass changes influenced the magnitude of the strength changes over time, strength declines in spite of muscle mass maintenance or even gain emphasize the need to explore the contribution of other cellular, neural, or metabolic mediators of strength changes.
Article
Full-text available
To compare the effects of a hydrotherapy resistance exercise programme with a gym based resistance exercise programme on strength and function in the treatment of osteoarthritis (OA). Single blind, three arm, randomised controlled trial. 105 community living participants aged 50 years and over with clinical OA of the hip or knee. Participants were randomised into one of three groups: hydrotherapy (n = 35), gym (n = 35), or control (n = 35). The two exercising groups had three exercise sessions a week for six weeks. At six weeks an independent physiotherapist unaware of the treatment allocation performed all outcome assessments (muscle strength dynamometry, six minute walk test, WOMAC OA Index, total drugs, SF-12 quality of life, Adelaide Activities Profile, and the Arthritis Self-Efficacy Scale). In the gym group both left and right quadriceps significantly increased in strength compared with the control group, and right quadriceps strength was also significantly better than in the hydrotherapy group. The hydrotherapy group increased left quadriceps strength only at follow up, and this was significantly different from the control group. The hydrotherapy group was significantly different from the control group for distance walked and the physical component of the SF-12. The gym group was significantly different from the control group for walk speed and self efficacy satisfaction. Compliance rates were similar for both exercise groups, with 84% of hydrotherapy and 75% of gym sessions attended. There were no differences in drug use between groups over the study period. Functional gains were achieved with both exercise programmes compared with the control group.
Article
Purpose: Meta-analysis of randomized controlled trials (RCTs) – of a hip powder of Rosa canina (rosehip) preparation for symptomatic treatment of osteoarthritis (OA), in order to estimate the empirical efficacy as a pain-reducing compound. Methods: RCTs from systematic searches were included if they explicitly stated that OA patients were randomized to either rosehip or placebo. The primary outcome was reduction in pain calculated as effect size (ES), defined as the standardized mean difference (SMD). As secondary analysis the number of responders to therapy was analyzed as Odds Ratios (OR), and expressed as the Number Needed to Treat (NNT). Restricted Maximum Likelihood (REML) methods were applied for the meta-analyses using mixed effects models. Results: The three studies (287 patients and a median trial-duration of 3 months) – all supported by the manufacturer (Hyben-Vital International) – showed a reduction in pain scores by rosehip powder (145 patients) compared to placebo (142 patients): ES of 0.37 [95% confidence interval (CI): 0.13−0.60], P = 0.002. Test for homogeneity seemed to support that the efficacy was consistent across trials (I-square = 0%). Thus it seems reasonable to assume that the three studies were measuring the same overall effect. It seemed twice as likely that a patient allocated to rosehip powder would respond to therapy, compared to placebo (OR = 2.19; P = 0.0009); corresponding to a NNT of six (95% CI: 4−13) patients (figure). Conclusions: Although based on a sparse amount of data, the results of the present meta-analysis indicate that rosehip powder does reduce pain; accordingly it may be of interest as a nutraceutical, although its efficacy and safety need evaluation and independent replication in a future large-scale/long-term trial.
Article
Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip OA report are based on expert opinion only. To determine whether land-based therapeutic exercise is beneficial for people with hip OA in terms of reduced joint pain and/or improved physical function. Five databases were searched from 1966 up until August 2008. All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. Three reviewers independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. Combining the results of the five included RCTs demonstrated a small treatment effect for pain, but no benefit in terms of improved self-reported physical function. Only one of these five RCTs exclusively recruited people with symptomatic hip OA. The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results. Adequately powered RCTs evaluating exercise programs specifically designed for people with symptomatic hip OA need to be conducted.
Article
Muscle weakness in old age is associated with physical function decline. Progressive resistance strength training (PRT) exercises are designed to increase strength. To assess the effects of PRT on older people and identify adverse events. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 01, 2008), EMBASE (1980 to February 06 2007), CINAHL (1982 to July 01 2007) and two other electronic databases. We also searched reference lists of articles, reviewed conference abstracts and contacted authors. Randomised controlled trials reporting physical outcomes of PRT for older people were included. Two review authors independently selected trials, assessed trial quality and extracted data. Data were pooled where appropriate. One hundred and twenty one trials with 6700 participants were included. In most trials, PRT was performed two to three times per week and at a high intensity. PRT resulted in a small but significant improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation measures also showed improvements: e.g. there was a modest improvement in gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme. This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.
Article
Biomechanical factors, such as reduced muscle strength and joint malalignment, have an important role in the initiation and progression of knee osteoarthritis (OA). Currently, there is no known cure for OA; however, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to therapeutic exercise. To determine whether land-based therapeutic exercise is beneficial for people with knee OA in terms of reduced joint pain or improved physical function. Five electronic databases were searched, up until December 2007. All randomized controlled trials randomising individuals and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. Two review authors independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. The 32 included studies provided data on 3616 participants for knee pain and 3719 participants for self-reported physical function. Meta-analysis revealed a beneficial treatment effect with a standardized mean difference (SMD) of 0.40 (95% confidence interval (CI) 0.30 to 0.50) for pain; and SMD 0.37 (95% CI 0.25 to 0.49) for physical function. There was marked variability across the included studies in participants recruited, symptom duration, exercise interventions assessed and important aspects of study methodology. The results were sensitive to the number of direct supervision occasions provided and various aspects of study methodology. While the pooled beneficial effects of exercise programs providing less than 12 direct supervision occasions or studies utilising more rigorous methodologies remained significant and clinically relevant, between study heterogeneity remained marked and the magnitude of the treatment effect of these studies would be considered small. There is platinum level evidence that land-based therapeutic exercise has at least short term benefit in terms of reduced knee pain and improved physical function for people with knee OA. The magnitude of the treatment effect would be considered small, but comparable to estimates reported for non-steroidal anti-inflammatory drugs.
Article
To assess the effectiveness of isolated resistance training on arthritis symptoms, physical performance, and psychological function in people with knee osteoarthritis. A comprehensive systematic database search for randomized controlled trials was performed. Two reviewers independently assessed studies for potential inclusion. Study quality indicators, arthritis symptoms, muscle strength, functional performance, and psychological outcomes were extracted. The relative effect sizes (ES) were calculated with 95% confidence intervals. Eighteen studies enrolling 2,832 subjects were reviewed; the mean cohort age range was 55-74 years. In general, the quality of the reviewed literature was moderately robust; on average, 8 out of 12 quality criteria were accounted for in the reviewed literature. Self-reported measures of pain, physical function, and performance, along with muscle strength (mean 17.4%), maximal gait speed and chair stand time, and balance improved significantly following resistance training in 56-100% of studies where they were measured. Limitations included lack of data available for ES calculations and lack of adverse event and compliance reporting, particularly with regard to the actual training intensity versus the prescribed training intensity. Resistance training improved muscle strength and self-reported measures of pain and physical function in over 50-75% of this cohort; 50-100% of the studies reported a significant improvement in all but 1 performance-based physical function measure (walk time). The effects of resistance training on health-related quality of life and depression are yet to be confirmed. More research needs to be conducted to establish dose-response relationships and the effect of resistance training on long-term disability, disease pathology, and progression.
Article
This review focuses on the age related declines in muscle mass and strength, including a discussion of the potential for improvement of neuromuscular function following exercise training programmes. In the literature, limb muscles have been compared between groups of men and women throughout the adult age range, showing that decreases in voluntary strength do not become apparent until after the age of about 60. Rate of decline then amounts to 10 to 15% per decade, stemming from age related decreases in the amount of excitable muscle tissue. However, high-resistance exercise training programmes are effective in improving both muscle size and voluntary strength, even in very old and frail men and women. These improvements may yield significant gains in the performance of sports and the activities of daily living, such as walking ability. Maintenance exercise programmes must also be advocated to avoid rapid detraining effects seen in elderly people who become sedentary.
Article
Maintenance of muscle mass and strength contributes to mobility which impacts on quality of life. Although muscle atrophy, declining strength, and physical frailty are generally accepted as inevitable concomitants of aging, the causes are unknown. Clarification of the mechanisms responsible for these changes would enhance our understanding of the degree to which they are preventable or treatable. The decline in muscle function between maturity and old age is similar for muscles of many different animals including human beings, and is typified by the decreases of approximately 35% in maximum force, approximately 30% in maximum power, and 20% in normalized force (kN.m-2) and power (W.kg-1) of extensor digitorum longus (EDL) muscles in old compared with adult mice. Much of the age-associated muscle atrophy and declining strength may be explained by motor unit remodeling which appears to occur by selective denervation of muscle fibers with reinnervation by axonal sprouting from an adjacent innervated unit. Muscles in old mice appear more susceptible to injury than muscles in young or adult mice and have a decreased capacity for recovery. The process of age-related denervation may be aggravated by an increased susceptibility of muscles in old animals to contraction-induced injury coupled with impaired capacity for regeneration.
Article
This review briefly summarizes the current state of knowledge regarding age related changes in skeletal muscle, followed by a more in-depth review of ageing effects on animal and human motor units (MUs). Ageing in humans is generally associated with reductions in muscle mass (atrophy), leading to reduced voluntary and electrically evoked contractile strength by the 7th decade for most muscle groups studied. As well, contraction and one-half relaxation times are typically prolonged in muscles of the elderly. Evidence from animal and human studies points toward age associated MU loss as the primary mechanism for muscle atrophy, and such losses may be greatest among the largest and fastest MUs. However, based on studies in animals and humans, it appears that at least some of the surviving MUs are able to partially compensate for MU losses, as indicated by an increase in the average MU size with age. The fact that muscles in the elderly have fewer, but on average larger and slower, MUs has important implications for motor control and function in this population.
Article
This study was designed to determine whether an 8-week isokinetic muscle-strength-training program improved the functional health status of patients with osteoarthritis of the knee joint. Twenty volunteers with osteoarthritis of the knee joint were randomly assigned to either an experimental (n=10) or control (n=10) group. The experimental group completed six sets of five maximal contractions three times per week for 8 weeks on a Cybex II dynamometer at 90 degrees per second. Both groups were pre- and posttest for extension and flexion strength of the right and left legs, the 50-foot walk time, range of motion at the knee joint, the Osteoarthritis Screening Index (OASI), and the Arthritis Impact Measurement Scale (AIMS). There was a significant decrease in pain and stiffness, and a significant increase in mobility. There was also a significant decline in arthritis activity in the experimental group as measured by the OASI and AIMS. The experimental group significantly increased in all strength measures, while the control group increased in only right leg flexion and left leg extension across the training period.
Article
Although the relationship between strength and physical performance in older adults is probably non-linear, few empirical studies have demonstrated that this is so. In a population-based sample of adults aged 60–96 years (n = 409), leg strength was measured in four muscle groups (knee extensor, knee flexor, ankle plantar flexor, ankle dorsiflexor) of both legs using an isokinetic dynamometer. A leg strength score was calculated as the sum of the four strength measurements in the right leg. Usual gait speed was measured over a 15.2 metre course. With a linear model, leg strength explained 17% of the variance in gait speed. Non–linear models (quadratic and inverse) explained significantly more variance (22%). The nature of the non-linear relationship was that, in stronger subjects, there was no association between strength and gait speed, while in weaker subjects, there was an association. Body weight and age also explained significant amounts of variance in gait speed, while sex and height did not. The results supported the hypothesis of a non-linear relationship between leg strength and gait speed that is similar for older men and women. This finding represents a mechanism for how small changes in physiological capacity may have substantial effects on performance in frail adults, while large changes in capacity have little or no effect in healthy adults.
Article
To evaluate the effects of isokinetic exercise versus a program of patient education on pain and function in older persons with knee osteoarthritis. A randomized, comparative clinical trial, with interventions lasting 8 weeks and evaluations of 12 weeks. An outpatient Veterans Affairs Medical Center clinic and an affiliated university hospital. One hundred thirteen men and women between 50 and 80 years old with diagnosed osteoarthritis of the knee; 98 completed the entire assigned treatment. Patients received either a regimen of isokinetic exercise of the quadriceps muscle three times weekly over 8 weeks or a series of 4 discussions and lectures led by health care professionals. Variables studied for change were isokinetic and isometric quadriceps strength, pain and function determined by categorical and visual analog scales, and overall status using physician and patient global evaluations by the Arthritis Impact Scale, version 2, Western Ontario McMaster's Arthritis Index, and Medical Outcome Study Short Form 36. Both treatment groups showed significant strength gains (p < .05), which occurred over a wider velocity spectrum for the exercise group. Exercised patients also had improved pain scores for more of the variables measured than those receiving education. Both groups had positive functional outcomes and slightly improved measures of overall status. Isokinetic exercise is an effective and well-tolerated treatment for knee osteoarthritis, but a much less costly education program also showed some benefits.
Article
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.
Article
To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis (OA) of the knee. Forty-six community dwelling patients, aged 55 years or older with knee pain and radiographic evidence of knee OA, were randomized to a 4 month home based progressive strength training program or a nutrition education program (attention control). Thirty-eight patients completed the trial with an adherence of 84% to the intervention and 65% to the attention control. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index pain and physical function subscales. Secondary outcomes included clinical knee examination, muscle strength, physical performance measures, and questionnaires to measure quality of life variables. Patients in the strength training group who completed the trial had a 71% improvement in knee extension strength in the leg reported as most painful versus a 3% improvement in the control group (p < 0.01). In a modified intent to treat analysis, self-reported pain improved by 36% and physical function by 38% in the strength training group versus 11 and 21%, respectively, in the control group (p = 0.01 for between group comparison). In addition, those patients in the strength training group who completed the trial had a 43% mean reduction in pain (p = 0.01 vs controls), a 44% mean improvement in self-reported physical function (p < 0.01 vs controls), and improvements in physical performance, quality of life, and self-efficacy when compared to the control group. High intensity, home based strength training can produce substantial improvements in strength, pain, physical function and quality of life in patients with knee OA.
Article
To compare 16 weeks of isometric versus dynamic resistance training versus a control on knee pain and functioning among patients with knee osteoarthritis (OA). Randomized clinical trial. Outpatient setting. A total of 102 volunteer subjects with OA of the knee randomized to isometric (n=32) and dynamic (n=35) resistance training groups or a control (n=35). Strength exercises for the legs, 3 times weekly for 16 weeks. Dynamic group: exercises across a functional range of motion; isometric: exercises at discrete joint angles. The time to descend and ascend a flight of 27 stairs and to get down and up off of the floor. Knee pain was assessed immediately after each functional task. The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess perceived pain, stiffness, and functional ability. In the isometric group, time to perform all 4 functional tasks decreased (P<.05) by 16% to 23%. In the dynamic group, time to descend and ascend stairs decreased by 13% to 17%. Both groups decreased knee pain while performing the functional tasks by 28% to 58%. Other measures of pain and functioning were significantly and favorably affected in the training groups. The improvements in the 2 training groups as a result of their respective therapies were not significantly different. The control group did not change over the duration of the study. Dynamic or isometric resistance training improves functional ability and reduces knee joint pain of patients with knee OA.
Article
The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to reduce physical disability in older people. Randomized controlled trials were identified from searches of relevant databases and study reference lists and contacts with researchers. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Only randomized controlled trials utilizing PRT as the primary intervention in participants, whose group mean age was 60 years or older, were included. Data were pooled using fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest. 62 trials (n = 3674) compared PRT with a control group. 14 trials had data available to allow pooling of disability outcomes. Most trials were of poor quality. PRT showed a strong positive effect on strength, although there was significant heterogeneity (41 trials [n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI -0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined and prospectively monitored. PRT results in improvements to muscle strength and some aspects of functional limitation, such as gait speed, in older adults. However, based on current data, the effect of PRT on physical disability remains unclear. Further, due to the poor reporting of adverse events in trials, it is difficult to evaluate the risks associated with PRT.
Article
To assess the impact of lower extremity osteoarthritis (OA) on transitions to mobility difficulty, and to assess the influence of pain, excess weight, and quadriceps strength on these transitions. We analyzed longitudinal data acquired from 199 participants in the Women's Health and Aging Study II (ages 70-79 years) who initially reported no lower extremity limitation (e.g., difficulty walking one-quarter mile) or difficulty in activities of daily living (ADL; e.g., transferring). Prevalent lower extremity OA was determined from validated algorithms encompassing multiple data sources. Markov transition models were created to analyze the first transition from no difficulty at baseline to lower extremity limitations, ADL difficulty, or both 18, 36, and 72 months later. Compared with women without OA (n = 140), a higher proportion of women with lower extremity OA (n = 59) initially reported pain on most days and more severe pain while walking (P < 0.05). Women with OA were also heavier, with a higher proportion being obese or overweight (P < 0.001). Lower extremity OA, higher body mass index, and lower knee extensor strength independently increased the risk of transition to combined lower extremity and ADL difficulty first over 72 months. Lower extremity OA increased the likelihood of developing difficulty in both lower extremity tasks and ADL over 72 months in a cohort of initially high functioning older women. Two modifiable factors, higher relative weight and lower knee extensor strength, substantially impacted these transitions, and therefore warrant increased attention in the management of lower extremity OA.
Article
Quadriceps weakness is a risk factor for incident knee osteoarthritis (OA). We describe a randomized controlled trial of effects of lower-extremity strength training on incidence and progression of knee OA. A total of 221 older adults (mean age 69 years) were stratified by sex, presence of radiographic knee OA, and severity of knee pain, and were randomized to strength training (ST) or range-of-motion (ROM) exercises. Subjects exercised 3 times per week (twice at a fitness facility, once at home) for 12 weeks, followed by transition to home-based exercise after 12 months. Assessments of isokinetic lower-extremity strength and highly standardized knee radiographs were obtained at baseline and 30 months. Subjects in both groups lost lower-extremity strength over 30 months; however, the rate of loss was slower with ST than with ROM. Compared with ROM, ST decreased the mean rate of joint space narrowing (JSN) in osteoarthritic knees by 26% (P = not significant). However, the difference between ST and ROM groups with respect to frequency of knee OA progression in JSN consensus ratings was marginally significant (18% versus 28%; P = 0.094). In knees that were radiographically normal at baseline, JSN >0.50 mm was more common in ST than in ROM (34% versus 19%; P = 0.038). Incident JSN was unrelated to exercise adherence or changes in quadriceps strength or knee pain. The ST group retained more strength and exhibited less frequent progressive JSN over 30 months than the ROM group. The increase in incident JSN >0.50 mm in ST is unexplained and requires confirmation.
Article
Muscle strength training is important for people with knee osteoarthritis (OA). High-resistance exercise has been demonstrated to be more beneficial than low-resistance exercise for young subjects. The purpose of this study was to compare the effects of high- and low-resistance strength training in elderly subjects with knee OA. One hundred two subjects were randomly assigned to groups that received 8 weeks of high-resistance exercise (HR group), 8 weeks of low-resistance exercise (LR group), or no exercise (control group). Pain, function, walking time, and muscle torque were examined before and after intervention. Significant improvement for all measures was observed in both exercise groups. There was no significant difference in any measures between HR and LR groups. However, based on effect size between exercise and control groups, the HR group improved more than the LR group. Both high- and low-resistance strength training significantly improved clinical effects in this study. The effects of high-resistance strength training appear to be larger than those of low-resistance strength training for people with mild to moderate knee OA, although the differences between the HR and LR groups were not statistically significant.
Article
To examine whether the effects of 12 weeks of quadriceps strengthening on the knee adduction moment, pain, and function in people with medial knee osteoarthritis (OA) differ in those with and without varus malalignment. A single-blind, randomized controlled trial of 107 community volunteers with medial knee OA was conducted. Participants were stratified according to knee malalignment (more varus or more neutral) and then randomized into either a 12-week supervised home-based quadriceps strengthening group or a control group with no intervention. The primary outcome was the knee adduction moment, measured using 3-dimensional gait analysis. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index scores (measuring pain and physical function), step test score, stair climb test score, and maximum quadriceps isometric strength. Analyses of covariance were carried out based on intent-to-treat principles. Quadriceps strengthening did not significantly alter the knee adduction moment in either the more malaligned or the more neutral group (unadjusted knee adduction moment 0.12 and 0.05% Nm/BWxHT, respectively). Function did not improve significantly following quadriceps strengthening in either alignment group, but there was a significant improvement in knee pain in the more neutrally aligned group (P < 0.001). Quadriceps strengthening did not have any significant effect on the knee adduction moment in participants with either more varus or more neutral alignment. The benefits of quadriceps strengthening on pain were more evident in those with more neutral alignment. Knee alignment thus represents a local mechanical factor that can mediate symptomatic outcome from exercise interventions in knee OA.
  • Ih Rosenberg
  • Summary
  • Comments
Rosenberg IH. Summary Comments. American Journal of Clinical Nutrition. 1989; 50:1231–1233.
A systematic review of progressive resistance strength training in older adults
  • Latham