Physical Activity Levels and Functional Performance in the Osteoarthritis Initiative A Graded Relationship

Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 01/2011; 63(1):127-36. DOI: 10.1002/art.27760
Source: PubMed


Physical activity improves function in adults with arthritis, but it is unknown if there is a graded relationship between physical activity and functional benefit. This study was undertaken to examine the cross-sectional and longitudinal relationship between self-reported physical activity and observed functional performance in adults with knee osteoarthritis (OA).
The Osteoarthritis Initiative cohort included 2,589 patients with knee OA (2,301 with longitudinal followup data) who were ages 45-79 years at baseline. Prospective annual functional performance was assessed for 2 years using timed 20-meter walk tests. We used linear regression to estimate differences across physical activity quartiles in subsequent function (baseline and 1-year activity predicts 1-year and 2-year function, respectively) adjusted for demographic factors (age, sex, race/ethnicity, education level, and marital status) and health factors (OA severity, knee symptoms, knee pain, knee injury, body mass index, comorbidity, depression, smoking, alcohol use, and other joint pain).
Increasing physical activity levels had a significant graded relationship to functional performance. Adults in physical activity quartile groups from least active to most active had an average gait speed of 4.0, 4.2, 4.3, and 4.5 feet/second, respectively, at baseline (P for trend<0.001) and 4.0, 4.2, 4.3, and 4.5 feet/second, respectively, after 1 year (P for trend<0.001); increasing trends remained significant after adjusting for covariates. Findings were similar within sex and age groups.
These prospective data indicate a consistent graded relationship between physical activity level and better performance in adults with knee OA. These findings support guidelines that encourage patients with arthritis who cannot attain minimum recommended physical activity to be as active as possible.

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Available from: Rowland W Chang, Jan 07, 2014
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    • "The knee with worse measures was used in the analysis. Walking ability and endurance were measured by a 20-meter walk, averaged over two trials [27]. The chair stand test directly assessed leg strength and knee function and duration of time (seconds) needed to stand up and sit down five times as quickly as possible [28]. "
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    ABSTRACT: Obesity is associated with knee pain and is an independent predictor of incident knee osteoarthritis (OA); increased pain with movement often leads patients to adopt sedentary lifestyles to avoid pain. Detailed descriptions of pain management strategies by body mass index (BMI) level among OA patients are lacking. The objectives were to describe complementary and alternative medicine (CAM) and conventional medication use by BMI level and identify correlates of CAM use by BMI level. Using Osteoarthritis Initiative baseline data, 2,675 patients with radiographic tibiofemoral OA in at least one knee were identified. Use of CAM therapies and conventional medications was determined by interviewers. Variables included SF-12, CES-D, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee injury and Outcomes in Osteoarthritis Score quality of life. Multinomial logistic regression models adjusting for sociodemographic and clinical factors provided estimates of the association between BMI levels and treatment use; binary logistic regression identified correlates of CAM use. BMI was inversely associated with CAM use (45% users had BMI >=35 kg/m2; 54% had BMI <=25 kg/m2), but positively associated with conventional medication use (54% users had BMI >=35 kg/m2; 35.1% had BMI <=25 kg/m2). Those with BMI >=30 kg/m2 were less likely to use CAM alone or in combination with conventional medications when compared to patients with BMI <=25 kg/m2. CAM use is common among people with knee OA but is inversely associated with BMI. Understanding ways to further symptom management in OA among overweight and obese patients is warranted.
    Full-text · Article · Sep 2013 · BMC Complementary and Alternative Medicine
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    • "In the long term, physical inactivity may lead to functional decline [10,11]. To maintain and improve physical function, the promotion of PA is a cornerstone in the treatment of OA [12]. "
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    ABSTRACT: A large proportion of patients with knee and/or hip osteoarthritis (OA) do not meet the recommended levels of physical activity (PA). Therefore, we developed a web-based intervention that provides a tailored PA program for patients with knee and/or hip OA, entitled Join2move. The intervention incorporates core principles of the behaviour graded activity theory (BGA). The aim of this study was to investigate the preliminary effectiveness, feasibility and acceptability of Join2move in patients with knee and/or hip OA. A non-randomized pilot study was performed among patients with knee and/or hip OA. Primary outcomes were PA (SQUASH Questionnaire), physical function (HOOS and KOOS questionnaires) and self-perceived effect (7-point Likert scale). Baseline, 6 and 12 week follow-up data were collected via online questionnaires. To assess feasibility and acceptability, program usage (modules completed) and user satisfaction (SUS questionnaire) were measured as secondary outcomes. Participants from the pilot study were invited to be interviewed. The interviews focused on users’ experiences with Join2move. Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move. In the first usability test, software experts evaluated the website from a list of usability concepts. In the second test, users were asked to verbalize thoughts during the execution of multiple tasks. Twenty OA patients with knee and/or hip OA between 50 and 80 years of age participated in the pilot study. After six weeks, pain scores increased from 5.3 to 6.6 (p=0.04). After 12 weeks this difference disappeared (p=0.5). Overall, users were enthusiastic about Join2move. In particular, performing exercise at one's own pace without time or travel restrictions was cited as convenient. However, some minor flaws were observed. Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying. This paper outlines the preliminary effectiveness, feasibility and acceptability of a web-based PA intervention. Preliminary results from the pilot study revealed that PA scores increased, although differences were not statistically significant. Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and/or hip OA. The intervention was easy to use and the satisfaction with the program was high. Trial registration The Netherlands National Trial Register. Trial number: NTR2483
    Full-text · Article · May 2013 · BMC Medical Informatics and Decision Making
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    • "The monitoring of ambulatory activities using accelerometers is a reliable technique, providing continuous, unsupervised, objective monitoring of mobility [28]. In the field of OA, it is well known that afflicted patients suffer limitations in their walking ability as monitored using accelerometer [29–31]. In dogs, this device was deemed adequate for at-home activity monitoring [32] while being a valid tool to document the therapeutic outcome of an OA management [33]. "
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    ABSTRACT: Objective. The aim of this randomized placebo-controlled trial was to evaluate the beneficial effect of a whole plant extract of Brachystemma calycinum D. Don (BCD) in naturally occurring osteoarthritis (OA) in dogs. Methods. Dogs had stifle/hip OA and poor limb loading based on the peak of the vertically oriented ground reaction force (PVF) measured using a force platform. At baseline, PVF and case-specific outcome measure of disability (CSOM) were recorded. Dogs (16 per group) were then assigned to receive BCD (200 mg/kg/day) or a placebo. The PVF was measured at week (W) 3 and W6. Locomotor activity was recorded throughout the study duration using collar-mounted accelerometer, and CSOM was assessed biweekly by the owner. Results. BCD-treated dogs had higher PVF at W3 and W6 when compared to Baseline (P < 0.001) and at W6 when compared to placebo-treated dogs (P = 0.040). Higher daily duration (P = 0.024) and intensity (P = 0.012) of locomotor activity were observed in BCD-treated dogs compared to baseline. No significant change was observed in either group for CSOM. Conclusions. Treatment with BCD improved the limb impairment and enhanced the locomotor activity in dogs afflicted by naturally-occurring OA. Those preclinical findings provide interesting and new information about the potential of BCD as an OA therapeutic.
    Full-text · Article · Jul 2012 · Evidence-based Complementary and Alternative Medicine
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