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Abstract
Decades of research support the fact that much age-related deterioration is the result of the effects of sedentary lifestyles and the development of medical conditions rather than of aging itself. Elite older athletes, who demonstrate enhanced performance compared with historic cohorts and even some younger peers, are models of this paradigm. Many non-elite middle-aged adults and older adults continue to remain increasingly active throughout middle age and beyond. A continually growing body of basic science and clinical evidence demonstrates how active persons modulate physical decline through training. An updated understanding of how active adults defy age helps orthopaedic surgeons not only manage their patients' performance but also improve their lives. A large segment of sedentary older adults will benefit from counseling that encourages the pursuit of more active and healthier lifestyles.
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Hinterwimmer S, Feucht MJ, Steinbrech C, Graichen H, von Eisenhart-Rothe R. The effect of a six-month training program followed by a marathon run on knee joint cartilage volume and thickness in marathon beginners. Knee Surg Sports Traumatol Arthrosc 2014; 22:1353-9. [PMID: 24045919 DOI: 10.1007/s00167-013-2686-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of a 6-month period of intensive running followed by the participation at a marathon run on cartilage volume and thickness in knees of marathon beginners. METHODS Ten asymptomatic marathon beginners underwent a supervised 6-month training program, which was finalized by the participation at a marathon run. Three-dimensional quantitative magnetic resonance imaging was performed before the training program (baseline measurements) and 1 day after the marathon (follow-up measurements). Cartilage volume and thickness of the medial and lateral femur, medial and lateral tibia, and patella were measured using semiautomated cartilage segmentation and three dimensional data postprocessing. RESULTS Significant differences between baseline and follow-up measurements were observed at the lateral femur, where cartilage volume and thickness decreased by a mean of 3.2 ± 3.0% (p = 0.012) and 1.7 ± 1.6% (p = 0.010), respectively. No significant changes in cartilage volume and thickness were observed at the medial and lateral tibia, the medial femur, and the patella. CONCLUSION Significant cartilage loss was observed at the lateral femur; however, the measured values are comparable to previously reported precision errors for quantitative cartilage measurement and thus most likely not of clinical relevance. High-impact forces during long-distance running are well tolerated even in marathon beginners and do not lead to clinical relevant cartilage loss. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefan Hinterwimmer
- Department of Orthopedic Surgery, Research Group for Kinematics and Biomechanics, University of Frankfurt, 60528, Frankfurt, Germany
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Huleatt JB, Campbell KJ, Laprade RF. Nonoperative treatment approach to knee osteoarthritis in the master athlete. Sports Health 2014; 6:56-62. [PMID: 24427443 PMCID: PMC3874223 DOI: 10.1177/1941738113501460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Context: Middle-age and elderly participants in athletic activities frequently encounter the chronic disabling process of osteoarthritis. Knowledge of the treatment of knee osteoarthritis is needed to keep the master athlete active. Objective: This article reviews the current scientific evidence regarding recommendations for the maturing athlete, specifically discussing the strengths and weaknesses of dietary and lifestyle modifications, physical therapy, bracing, supplements, pharmacotherapies, and biologics in the management of knee osteoarthritis. Level of Evidence: Level 4. Conclusion: These treatment modalities can help keep the aging athlete active, which in itself plays an important role in reducing the symptoms of knee osteoarthritis.
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Kroman SL, Roos EM, Bennell KL, Hinman RS, Dobson F. Measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2014; 22:26-39. [PMID: 24216060 DOI: 10.1016/j.joca.2013.10.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/10/2013] [Accepted: 10/29/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To systematically appraise the evidence on measurement properties of performance-based outcome measures to assess physical function in young and middle-aged people known to be at high risk of hip and/or knee osteoarthritis (OA). METHODS Electronic searches were performed in MEDLINE, CINAHL, Scopus and SPORTDiscus in May 2013. Two reviewers independently rated the measurement properties using the 4-point COSMIN checklist. Best evidence synthesis was made using COSMIN quality, consistency and direction of findings and sample size. RESULTS Twenty of 2736 papers were eligible for inclusion and 24 different performance-based outcome measures knee or obese populations were evaluated. No tests related to hip populations were included. Twenty-five measurement properties including reliability (nine studies), construct validity (hypothesis testing) (nine studies), measurement error (three studies), structural validity (two studies), interpretability (one study) and responsiveness (one study) were evaluated. A positive rating was given to 12.5% (30/240) of all possible measurement ratings. Tests were grouped into two categories based on the population characteristics. The one-legged hop for distance, followed by the 6-m timed hop and cross over hop for distance were the best-rated tests for the knee-injured population. Whereas the 6-min walk test was the only included test for the obese population. CONCLUSION This review highlights the many gaps in knowledge about the measurement properties of performance-based outcome measures for young and middle-aged people known to be at high risk of hip and/or knee OA. There is a need for consensus on which outcome measures should be used and/or combined when assessing physical function in this population. Further good quality research is required.
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Affiliation(s)
- S L Kroman
- Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Denmark.
| | - E M Roos
- Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Denmark.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - F Dobson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
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Bennell K, Hinman RS, Wrigley TV, Creaby MW, Hodges P. Exercise and osteoarthritis: cause and effects. Compr Physiol 2013; 1:1943-2008. [PMID: 23733694 DOI: 10.1002/cphy.c100057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) is a common chronic joint condition predominantly affecting the knee, hip, and hand joints. Exercise plays a role in the development and treatment of OA but most of the literature in this area relates to knee OA. While studies indicate that exercise and physical activity have a generally positive effect on healthy cartilage metrics, depending upon the type of the activity and its intensity, the risk of OA development does appear to be moderately increased with sporting participation. In particular, joint injury associated with sports participation may be largely responsible for this increased risk of OA with sport. Various repetitive occupational tasks are also linked to greater likelihood of OA development. There are a number of physical impairments associated with OA including pain, muscle weakness and altered muscle function, reduced proprioception and postural control, joint instability, restricted range of motion, and lower aerobic fitness. These can result directly from the OA pathological process and/or indirectly as a result of factors such as pain, effusion, and reduced activity levels. These impairments and their underlying physiology are often targeted by exercise interventions and evidence generally shows that many of these can be modified by specific exercise. There is currently little clinical trial evidence to show that exercise can alter mechanical load and structural disease progression in those with established OA, although a number of impairments, that are amenable to change with exercise, appears to be associated with increased mechanical load and/or disease progression in longitudinal studies.
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Affiliation(s)
- Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Zingg MA, Pazahr S, Morsbach F, Gutzeit A, Wiesner W, Lutz B, Knechtle B, Rosemann T, Mundinger PM, Rüst CA. No damage of joint cartilage of the lower limbs in an ultra-endurance athlete--an MRI-study. BMC Musculoskelet Disord 2013; 14:343. [PMID: 24314152 PMCID: PMC3903073 DOI: 10.1186/1471-2474-14-343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022] Open
Abstract
Background Osteoarthritis is an increasing burden in an ageing population. Sports, especially when leading to an overstress of joints, is under suspicion to provoke or at least accelerate the genesis of osteoarthritis. We present the radiologic findings of a 49-years old ultra-endurance athlete with 35 years of training and competing, whose joints of the lower limbs were examined using three different types of magnetic resonance imaging, including a microscopic magnetic resonance imaging coil. To date no case report exists where an ultra-endurance athlete was examined such detailed regarding overuse-injuries of his joints. Case presentation A 49 years old, white, male ultra-endurance athlete reporting no pain during training and racing and with no significant injuries of the lower limbs in his medical history was investigated regarding signs of chronic damage or overuse injuries of the joints of his lower limbs. Conclusion Despite the age of nearly 50 years and a training history of over 35 years, the athlete showed no signs of chronic damage or overuse injuries in the joints of his lower limbs. This leads to the conclusion that extensive sports and training does not compulsory lead to damages of the musculoskeletal system. This is a very important finding for all endurance-athletes as well as for their physicians.
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Affiliation(s)
| | | | | | | | | | | | - Beat Knechtle
- Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland.
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Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2013; 2:1143-211. [PMID: 23798298 DOI: 10.1002/cphy.c110025] [Citation(s) in RCA: 1256] [Impact Index Per Article: 114.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.
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Affiliation(s)
- Frank W Booth
- Departments of Biomedical Sciences, Medical Pharmacology and Physiology, and Nutrition and Exercise Physiology, Dalton Cardiovascular Institute, University of Missouri, Columbia, Missouri, USA.
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Franciozi CES, Tarini VAF, Reginato RD, Gonçalves PRS, Medeiros VP, Ferretti M, Dreyfuss JL, Nader HB, Faloppa F. Gradual strenuous running regimen predisposes to osteoarthritis due to cartilage cell death and altered levels of glycosaminoglycans. Osteoarthritis Cartilage 2013; 21:965-72. [PMID: 23602983 DOI: 10.1016/j.joca.2013.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/18/2013] [Accepted: 04/06/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the hypothesis that strenuous running is a predisposing factor for osteoarthritis. DESIGN Wistar rats were divided into two groups: a control group (CG) and a trained group (TG). The TG underwent a strenuous treadmill running training regimen of controlled intensity, exhibiting progressively improvement of fitness over 12 weeks, running at least 55 km during this period and finally performing an ultra-endurance running exercise to exhaustion. After this period, rats from both groups were euthanized and their knees removed. The articular cartilage was dissected and submitted to histomorphometrical, histomorphological, and immunohistochemical analyses evaluating cell death pathway (caspase-3 and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL)) and inflammatory cytokines [interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α)]. In addition, the tissues were analyzed regarding the types and the content of glycosaminoglycans. RESULTS The TG knee joints exhibited increase in the number of chondrocytes and chondrocyte clusters, as well as significantly increased levels of caspase-3, a protein involved in apoptosis, and of inflammatory cytokines IL-1α and TNF-α. In addition, histologically higher grades of osteoarthritis (Osteoarthritis Research Society International - OARSI grading), and significantly decreased levels of chondroitin sulfate and hyaluronic acid. Knee cartilage thickness and TUNEL did not significantly differ between the two groups. CONCLUSIONS The articular cartilage of rats subjected to a strenuous running regimen of controlled intensity exhibited molecular and histological characteristics that are present in osteoarthritis.
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Affiliation(s)
- C E S Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Gaught AM, Carneiro KA. Evidence for determining the exercise prescription in patients with osteoarthritis. PHYSICIAN SPORTSMED 2013; 41:58-65. [PMID: 23445861 DOI: 10.3810/psm.2013.02.2000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Osteoarthritis (OA) is a chronic joint disease that affects more than one-third of older adults (age > 65 years), most often involving the hip and knee. Osteoarthritis causes pain and limits mobility, thereby reducing patient quality of life. Conservative, nonsurgical, nonpharmacologic treatment strategies include weight reduction, orthotics, physical therapy modalities, acupuncture, massage, and exercise. The breadth of the current literature on OA can make determining the appropriate exercise prescription challenging. Aerobic exercise, strengthening exercise, Tai chi, and aquatic exercise can all alleviate pain and improve function in patients with OA. The choice of the specific type and mode of delivery of the exercise should be individualized and should consider the patient's preferences. Ongoing monitoring and supervision by a health care professional are essential for patients to participate in and benefit from exercise.
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Affiliation(s)
- Amber M Gaught
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
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61
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The theory and practice of active aging. Curr Gerontol Geriatr Res 2012; 2012:420637. [PMID: 23118746 PMCID: PMC3483833 DOI: 10.1155/2012/420637] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/18/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
“Active aging” connotes a radically nontraditional paradigm of aging which posits possible improvement in health despite increasing longevity. The new paradigm is based upon postponing functional declines more than mortality declines and compressing morbidity into a shorter period later in life. This paradigm (Compression of Morbidity) contrasts with the old, where increasing longevity inevitably leads to increasing morbidity. We have focused our research on controlled longitudinal studies of aging. The Runners and Community Controls study began at age 58 in 1984 and the Health Risk Cohorts study at age 70 in 1986. We noted that disability was postponed by 14 to 16 years in vigorous exercisers compared with controls and postponed by 10 years in low-risk cohorts compared with higher risk. Mortality was also postponed, but too few persons had died for valid comparison of mortality and morbidity. With the new data presented here, age at death at 30% mortality is postponed by 7 years in Runners and age at death at 50% (median) mortality by 3.3 years compared to controls. Postponement of disability is more than double that of mortality in both studies. These differences increase over time, occur in all subgroups, and persist after statistical adjustment.
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62
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Holden MA, Nicholls EE, Young J, Hay EM, Foster NE. Role of exercise for knee pain: What do older adults in the community think? Arthritis Care Res (Hoboken) 2012; 64:1554-64. [DOI: 10.1002/acr.21700] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ratzlaff CR, Koehoorn M, Cibere J, Kopec JA. Is lifelong knee joint force from work, home, and sport related to knee osteoarthritis? Int J Rheumatol 2012; 2012:584193. [PMID: 22848225 PMCID: PMC3405641 DOI: 10.1155/2012/584193] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/14/2012] [Accepted: 05/14/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the association of cumulative lifetime knee joint force on the risk of self-reported medically-diagnosed knee osteoarthritis (OA). Methods. Exposure data on lifetime physical activity type (occupational, household, sport/recreation) and dose (frequency, intensity, duration) were collected from 4,269 Canadian men and women as part of the Physical Activity and Joint Heath cohort study. Subjects were ranked in terms of the "cumulative peak force index", a measure of lifetime mechanical knee force. Multivariable logistic regression was conducted to obtain adjusted effects for mean lifetime knee force on the risk of knee OA. Results. High levels of total lifetime, occupational and household-related force were associated with an increased in risk of OA, with odds ratio's ranging from approximately 1.3 to 2. Joint injury, high BMI and older age were related to risk of knee OA, consistent with previous studies. Conclusions. A newly developed measure of lifetime mechanical knee force from physical activity was employed to estimate the risk of self-reported, medically-diagnosed knee OA. While there are limitations, this paper suggests that high levels of total lifetime force (all domains combined), and occupational force in men and household force in women were risk factors for knee OA.
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Affiliation(s)
- Charles R Ratzlaff
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street PBB3, Boston, MA 02115, USA
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64
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Hansen P, English M, Willick SE. Does Running Cause Osteoarthritis in the Hip or Knee? PM R 2012; 4:S117-21. [DOI: 10.1016/j.pmrj.2012.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/29/2022]
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65
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Esser S, Bailey A. Effects of exercise and physical activity on knee osteoarthritis. Curr Pain Headache Rep 2012; 15:423-30. [PMID: 21956792 DOI: 10.1007/s11916-011-0225-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Exercise is one of the most discussed and controversial nonpharmacologic management strategies for osteoarthritis (OA) of the knee. Health care providers and patients share varied and often pseudoscientific beliefs regarding the effects of exercise on knee OA formulated on outdated notions of the etiology, pathophysiology, and progression of the condition. Based on the contemporary literature, regular light to moderate physical activity has both preventive and therapeutic benefits for individuals with knee OA. Exercise regimens with strong evidence of benefit include those that focus on aerobic/cardiovascular conditioning and lower extremity strength training. Health care providers should confidently incorporate exercise recommendations into clinical management and offer patients evidence-based and individually tailored exercise prescriptions to help manage the painful and often disabling symptoms of this condition.
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Affiliation(s)
- Stephan Esser
- Harvard Medical School, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
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66
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Nielsen RO, Buist I, Sørensen H, Lind M, Rasmussen S. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther 2012; 7:58-75. [PMID: 22389869 PMCID: PMC3290924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
PURPOSE The purpose of this systematic review was to examine the link between training characteristics (volume, duration, frequency, and intensity) and running related injuries. METHODS A systematic search was performed in PubMed, Web of Science, Embase, and SportDiscus. Studies were included if they examined novice, recreational, or elite runners between the ages of 18 and 65. Exposure variables were training characteristics defined as volume, distance or mileage, time or duration, frequency, intensity, speed or pace, or similar terms. The outcome of interest was Running Related Injuries (RRI) in general or specific RRI in the lower extremity or lower back. Methodological quality was evaluated using quality assessment tools of 11 to 16 items. RESULTS After examining 4561 titles and abstracts, 63 articles were identified as potentially relevant. Finally, nine retrospective cohort studies, 13 prospective cohort studies, six case-control studies, and three randomized controlled trials were included. The mean quality score was 44.1%. Conflicting results were reported on the relationships between volume, duration, intensity, and frequency and RRI. CONCLUSION It was not possible to identify which training errors were related to running related injuries. Still, well supported data on which training errors relate to or cause running related injuries is highly important for determining proper prevention strategies. If methodological limitations in measuring training variables can be resolved, more work can be conducted to define training and the interactions between different training variables, create several hypotheses, test the hypotheses in a large scale prospective study, and explore cause and effect relationships in randomized controlled trials. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Rasmus Oestergaard Nielsen
- Aarhus University, Department of Public Health, Aarhus C. Denmark
- Orthopaedic Research Unit, Science and Innovation Center, Aalborg Hospital Aarhus University, DK-9000 Aalborg C. Denmark
| | - Ida Buist
- Center for Sports Medicine, University of Groningen, The Netherlands
| | - Henrik Sørensen
- Aarhus University, Department of Public Health, Aarhus C. Denmark
| | - Martin Lind
- Department of Orthopedics Aarhus University Hospital, Aarhus C., Denmark
| | - Sten Rasmussen
- Orthopaedic Research Unit, Science and Innovation Center, Aalborg Hospital Aarhus University, DK-9000 Aalborg C. Denmark
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Abstract
PURPOSE Osteoarthritis of the knee is a complex interaction of biological, mechanical, and biochemical factors that are further complicated by injury, which accelerates pathological processes within the joint. As a result, athletes, particularly those with a history of knee injury, have an earlier onset and higher prevalence of osteoarthritis that would be expected based on their age. This can present a clinical dilemma to the physician managing the patient who, despite the presence of radiologically confirmed disease, has few symptoms and wishes to maintain an active lifestyle. METHODS We reviewed meta-analyses and systematic reviews of randomized controlled trials about clinical management of knee osteoarthritis with special interest on effect sizes. RESULTS Numerous management options have undergone the rigor of clinical trials and subsequently have been summarized in meta-analyses and systematic reviews, the results of which offer evidence regarding varying degrees of effect. Based on the available evidence, most summaries and clinical practice guidelines suggest a regimen of patient education, self-management, weight control, and exercise supported by individualized pain management strategies. Other noninvasive or less invasive strategies are available that have varying degrees of effect. CONCLUSIONS Although the evidence supporting many of the clinical management options might be considered modest, those effects are sufficient to permit an active lifestyle and have, given the prevalence of the disease, a public health impact.
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Affiliation(s)
| | - William E Garrett
- Sports Medicine Section, Duke University Medical Center, Durham, NC, USA
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Hovis KK, Stehling C, Souza RB, Haughom BD, Baum T, Nevitt M, McCulloch C, Lynch JA, Link TM. Physical activity is associated with magnetic resonance imaging-based knee cartilage T2 measurements in asymptomatic subjects with and those without osteoarthritis risk factors. ACTA ACUST UNITED AC 2011; 63:2248-56. [PMID: 21538328 DOI: 10.1002/art.30419] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the association of exercise and knee-bending activities with magnetic resonance imaging (MRI)-based knee cartilage T2 relaxation times and morphologic abnormalities in asymptomatic subjects from the Osteoarthritis Initiative, with or without osteoarthritis (OA) risk factors. METHODS We studied 128 subjects with knee OA risk factors and 33 normal control subjects ages 45-55 years, with a body mass index of 18-27 kg/m(2) and no knee pain. Subjects were categorized according to exercise level, using the leisure activity component of the Physical Activity Scale for the Elderly, and by self-reported frequent knee-bending activities. Two radiologists graded the cartilage of the right knee on MR images, using the Whole-Organ MRI Score (WORMS). Cartilage was segmented, and compartment-specific T2 values were calculated. Differences between the exercise groups and knee-bending groups were determined using multiple linear and logistic regression models. RESULTS Among subjects with risk factors for knee OA, light exercisers had lower T2 values compared with sedentary and moderate/strenuous exercisers. When the sexes were analyzed separately, female moderate/strenuous exercisers had higher T2 values compared with sedentary individuals and light exercisers. Subjects without risk factors displayed no significant differences in T2 values according to exercise level. However, frequent knee-bending activities were associated with higher T2 values in both subjects with OA risk factors and those without OA risk factors and with more severe cartilage lesions in the group with risk factors. CONCLUSION In subjects at risk of knee OA, light exercise was associated with low T2 values, whereas moderate/strenuous exercise in women was associated with high T2 values. Higher T2 values and WORMS grades were also observed in frequent knee-benders, suggesting greater cartilage degeneration in these individuals.
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Fries JF, Bruce B, Chakravarty E. Compression of morbidity 1980-2011: a focused review of paradigms and progress. J Aging Res 2011; 2011:261702. [PMID: 21876805 PMCID: PMC3163136 DOI: 10.4061/2011/261702] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/07/2011] [Indexed: 12/31/2022] Open
Abstract
The Compression of Morbidity hypothesis—positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability—was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based “healthy aging” interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity.
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Affiliation(s)
- James F Fries
- Department of Medicine, Stanford University School of Medicine, 1000 Welch Road, Suite 203, Stanford, CA 94304, USA
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Urquhart DM, Tobing JFL, Hanna FS, Berry P, Wluka AE, Ding C, Cicuttini FM. What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc 2011; 43:432-42. [PMID: 20631641 DOI: 10.1249/mss.0b013e3181ef5bf8] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Although several studies have examined the relationship between physical activity and knee osteoarthritis, the effect of physical activity on knee joint health is unclear. The aim of this systematic review was to examine the relationships between physical activity and individual joint structures at the knee. METHODS Computer-aided searches were conducted up until November 2008, and the reference lists of key articles were examined. The methodological quality of selected studies was assessed based on established criteria, and a best-evidence synthesis was used to summarize the results. RESULTS We found that the relationships between physical activity and individual joint structures at the knee differ. There was strong evidence for a positive association between physical activity and tibiofemoral osteophytes. However, we also found strong evidence for the absence of a relationship between physical activity and joint space narrowing, a surrogate method of assessing cartilage. Moreover, there was limited evidence from magnetic resonance imaging studies for a positive relationship between physical activity and cartilage volume and strong evidence for an inverse relationship between physical activity and cartilage defects. CONCLUSIONS This systematic review found that knee structures are affected differently by physical activity. Although physical activity is associated with an increase in radiographic osteophytes, there was no related increase in joint space narrowing, rather emerging evidence of an associated increase in cartilage volume and decrease in cartilage defects on magnetic resonance imaging. Given that optimizing cartilage health is important in preventing osteoarthritis, these findings indicate that physical activity is beneficial, rather than detrimental, to joint health.
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Affiliation(s)
- Donna M Urquhart
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
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Functional adaptation of knee cartilage in asymptomatic female novice runners compared to sedentary controls. A longitudinal analysis using delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC). Osteoarthritis Cartilage 2010; 18:1564-9. [PMID: 20950697 DOI: 10.1016/j.joca.2010.10.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 09/15/2010] [Accepted: 10/04/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To longitudinally estimate the change in glycosaminoglycan content of knee cartilage in asymptomatic untrained female novice runners participating in a Start To Run program (STR) compared to sedentary controls. METHOD Nine females enrolling in a 10-week STR and 10 sedentary controls participated voluntarily. Prior to and after the 10-week period, both groups were subjected to dGEMRIC imaging. dGEMRIC indices of knee cartilage were determined at baseline and for the change after the 10-week period in both groups. Based on a self-reported weekly log, physical activity change during the study was depicted as decreased, unchanged or increased. The Mann-Whitney U and Kruskal-Wallis tests were applied to test the hypotheses that dGEMRIC changes occurred between groups and according to physical activity changes respectively. RESULTS No significant differences were established between groups for dGEMRIC indices at baseline (P=0.541). A significant positive change of the median dGEMRIC index in the runners group was demonstrated when compared to the controls [+11.66ms (95% CI: -25.29, 44.43) vs -9.56ms (95% CI: -29.55, 5.83), P=0.006]. The change in dGEMRIC index differed significantly according to physical activity change (P=0.014), showing an increase in dGEMRIC index with increasing physical activity. CONCLUSION Since cartilage appears to positively respond to moderate running when compared to a sedentary lifestyle, this running scheme might be considered a valuable tool in osteoarthritis prevention strategies. Caution is warranted when applying these results to a wider population and to longer training periods.
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Luke AC, Stehling C, Stahl R, Li X, Kay T, Takamoto S, Ma B, Majumdar S, Link T. High-field magnetic resonance imaging assessment of articular cartilage before and after marathon running: does long-distance running lead to cartilage damage? Am J Sports Med 2010; 38:2273-80. [PMID: 20631252 DOI: 10.1177/0363546510372799] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is continuing controversy whether long-distance running results in irreversible articular cartilage damage. New quantitative magnetic resonance imaging (MRI) techniques used at 3.0 T have been developed including T1rho (T1ρ) and T2 relaxation time measurements that detect early cartilage proteoglycan and collagen breakdown. HYPOTHESIS Marathon runners will demonstrate T1ρ and T2 changes in articular cartilage on MRI after a marathon, which are not seen in nonrunners. These changes are reversible. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Ten asymptomatic marathon runners had 3-T knee MRI scans 2 weeks before, within 48 hours after, and 10 to 12 weeks after running a marathon. The T1ρ and T2 MRI sequences in runners were compared with those of 10 age- and gender-matched controls who had MRI performed at baseline and 10 to 12 weeks. RESULTS Runners did not demonstrate any gross morphologic MRI changes after running a marathon. Postmarathon studies, however, revealed significantly higher T2 and T1ρ values in all articular cartilage areas of the knee (P < .01) except the lateral compartment. The T2 values recovered to baseline except in the medial femoral condyle after 3 months. Average T1ρ values increased after the marathon from 37.0 to 38.9 (P < .001) and remained increased at 3 months. CONCLUSION Runners showed elevated T1ρ and T2 values after a marathon, suggesting biochemical changes in articular cartilage, T1ρ values remain elevated after 3 months of reduced activity. The patellofemoral joint and medial compartment of the knee show the highest signal changes, suggesting they are at higher risk for degeneration.
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Affiliation(s)
- Anthony C Luke
- Anthony C. Luke, University of California, San Francisco, Department of Orthopaedics, 500 Parnassus Ave, MU-320W, San Francisco, CA 94143-0728, USA.
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Stehling C, Lane NE, Nevitt MC, Lynch J, McCulloch CE, Link TM. Subjects with higher physical activity levels have more severe focal knee lesions diagnosed with 3T MRI: analysis of a non-symptomatic cohort of the osteoarthritis initiative. Osteoarthritis Cartilage 2010; 18:776-86. [PMID: 20202488 PMCID: PMC4839980 DOI: 10.1016/j.joca.2010.02.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 02/01/2010] [Accepted: 02/06/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the prevalence of focal knee abnormalities using 3 Tesla (T) magnetic resonance (MR) studies in relation to physical activity levels in asymptomatic, middle-aged subjects from the osteoarthritis initiative (OAI). MATERIAL AND METHODS We analyzed baseline data from 236, 45-55 years old individuals (136 women, 100 men) without knee pain (based on Western Ontario and McMaster University scores) and a body mass index (BMI) of 19-27 kg/m(2). Physical activity levels were determined in all subjects using the Physical Activity Scale for the Elderly (PASE). MR imaging (MRI) at 3T was performed using coronal intermediate-weighted (IW) 2D fast spin-echo (FSE), sagittal 3D dual-echo in steady state (DESS) and 2D IW fat-suppressed (fs) FSE sequences of the right knee. All images were analyzed by two musculoskeletal radiologists identifying and grading cartilage, meniscal, ligamentous and other knee abnormalities using the whole-organ MR imaging score (WORMS) MRI OA scoring method. Statistical significances between subjects with different activity levels were determined using one-way analysis of variance (ANOVA), chi-square tests and a multi-variate regression model adjusted for gender, age, BMI, Kellgren-Lawrence (KL) score and osteoarthritis (OA) risk factors. RESULTS Meniscal lesions were found in 47% of the 236 subjects, cartilage lesions in 74.6%, bone marrow edema pattern (BMEP) in 40.3% and ligament lesions in 17%. Stratification of subjects by physical activity resulted in an increasing incidence of cartilage, meniscus and ligament abnormalities, BMEP and joint effusion according to activity levels (PASE). The severity grade of cartilage lesions was also associated with PASE levels and presence of other knee abnormalities was also significantly associated with cartilage defects. CONCLUSION Asymptomatic middle-aged individuals from the OAI incidence cohort had a high prevalence of knee abnormalities; more physically active individuals had significantly more and more severe knee abnormalities independently of gender, age, BMI, KL score and OA risk factors. These data therefore also suggest that subjects with higher physical activity levels may be at greater risk for cartilage, meniscus and ligament abnormalities, but the analysis of the longitudinal data will show whether these subjects will demonstrate accelerated progress.
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Affiliation(s)
- Christoph Stehling
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA,Department of Clinical Radiology, University of Muenster, Muenster, Germany
| | - Nancy E. Lane
- UC Davis Center for Healthy Aging, Sacramento, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - John Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Abstract
The popularity of marathon running has increased during recent years, which is reflected by the dramatic increase in the number of competitions and participants. Running a marathon itself does not usually cause any severe lesions of the joints but the problems mostly occur during training prior to the marathon. Before the event runners often question whether they can successfully take part in the competition and cope with the pain that might occur during running. In addition to the rare acute trauma, which is in general caused by falls or slipping, chronic injuries are of particular relevance for long distance running.This article describes the typical patterns of injuries to long distance runners, the positive effects of running a marathon and the risk factors for injuries.
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Stehling C, Liebl H, Krug R, Lane NE, Nevitt MC, Lynch J, McCulloch CE, Link TM. Patellar cartilage: T2 values and morphologic abnormalities at 3.0-T MR imaging in relation to physical activity in asymptomatic subjects from the osteoarthritis initiative. Radiology 2009; 254:509-20. [PMID: 20019141 DOI: 10.1148/radiol.09090596] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the interrelationship between patella cartilage T2 relaxation time, other knee abnormalities, and physical activity levels in asymptomatic subjects from the Osteoarthritis Initiative (OAI) incidence cohort. MATERIALS AND METHODS The study had institutional review board approval and was HIPAA compliant. One hundred twenty subjects from the OAI without knee pain (age, 45-55 years) and with risk factors for knee osteoarthritis (OA) were studied by using knee radiographs, 3.0-T knee magnetic resonance (MR) images (including intermediate-weighted fast spin-echo and T2 mapping sequences), and the Physical Activity Scale for the Elderly. MR images of the right knee were assessed by two musculoskeletal radiologists for the presence and grade of abnormalities. Segmentation of the patella cartilage was performed, and T2 maps were generated. Statistical significance was determined by using analysis of variance, chi(2) analysis, correlation coefficient tests, the Cohen kappa, and a multiple linear regression model. RESULTS Cartilage lesions were found in 95 (79.0%) of 120 knees, and meniscal lesions were found in 54 (45%) of 120 knees. A significant correlation between patella cartilage T2 values and the severity and grade of cartilage (P = .0025) and meniscus (P = .0067) lesions was demonstrated. Subjects with high activity levels had significantly higher prevalence and grade of abnormalities and higher T2 values (48.7 msec +/-4.35 vs 45.8 msec +/-3.93; P < .001) than did subjects with low activity levels. CONCLUSION Middle-aged asymptomatic individuals with risk factors for knee OA had a high prevalence of cartilage and meniscus knee lesions. Physically active individuals had more knee abnormalities and higher patellar T2 values. Additional studies will be needed to determine causality.
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Affiliation(s)
- Christoph Stehling
- Musculoskeletal and Quantitative Imaging Group, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107, USA.
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Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The Effect of Running Shoes on Lower Extremity Joint Torques. PM R 2009; 1:1058-63. [DOI: 10.1016/j.pmrj.2009.09.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 08/26/2009] [Accepted: 09/22/2009] [Indexed: 11/24/2022]
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Bosomworth NJ. Exercise and knee osteoarthritis: benefit or hazard? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2009; 55:871-878. [PMID: 19752252 PMCID: PMC2743580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine whether physical exercise constitutes a benefit or a risk in the development and progression of knee osteoarthritis. QUALITY OF EVIDENCE MEDLINE, EMBASE, DARE, ACP Journal Club, and Cochrane databases were searched from registry inception to January 2009 using MeSH headings or text words, including osteoarthritis, arthritis and knee and exercise, physical training, and run. Reference lists from retrieved articles, citation listings when available, and related articles suggested in PubMed were also evaluated. For individuals without osteoarthritis, strong level II evidence was found (limited by problems with blinding and randomization); for those with pre-existing knee osteoarthritis, robust level I evidence was available. MAIN MESSAGE Knee osteoarthritis is a major contributor to disability in seniors, and patients have expressed concern that continued exercise might lead to knee symptoms in later years. Studies done on subjects self-selected for exercise and followed for substantial periods of time show no evidence of accelerated development of osteoarthritis, provided injury is avoided. Further, there is good evidence for reduced pain and disability with exercise in this cohort compared with controls. Patients with established osteoarthritis are shown to derive uniform benefit to physical functioning, with reduction of pain and disability, using aerobic, muscle strengthening, aquatic, or physiotherapy-based exercise modalities. CONCLUSION Provided trauma is avoided, moderate exercise does not lead to acceleration of knee osteoarthritis, whether or not there is evidence of pre-existing disease. In either case there appears to be improved physical functioning and reduction of pain and disability in those who exercise. It is likely that exercise interventions are underused in the management of established knee osteoarthritis symptoms.
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Affiliation(s)
- Neil J Bosomworth
- Department of Family Practice, University of British Columbia, Vancouver.
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