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Fitness & Exercise for Senior Citizens
Senior Citizens Need More Exercise, Not Less, to
Avoid Osteoarthritis
Study of physical activity impact on knee joint
says exercise for heart is what's needed for knee
 Sept. 8, 2007 – Physical exercise that is good for
the heart, is also good for the older person’s knee, says research
published in the October 2007 issue of Arthritis Care & Research.
Sporting events for senior citizens sometimes looks like a gathering of
mechanical robots, with all the gear and wrapping around their knees and
other joints. It is osteoarthritis, however, that too often causes
disability among those over age 50 but this study says vigorous exercise
may prevent the problem.
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Osteoarthritis is the world’s most common joint
disease. Whether physical activity is beneficial or detrimental to
weight-bearing joints, knees in particular, has been open to debate.
Some studies implicate physical activity in provoking knee OA, while
others suggest that physical activity may actually protect the knee
joint from the disease.
Confounding the matter is the fact that knee injury
is a known risk factor for knee OA. Then, there’s the unclear role of
osteophytes (small outgrowth of bone that occurs within joints or at
other sites where there is degeneration of cartilage) in knee OA
progression. This is compounded by the limitations of radiographs for
monitoring small yet significant changes in joint structure.
For a clearer picture of the impact of physical
activity on the knee joint, a team of researchers in Australia turned to
magnetic resonance imaging (MRI). This highly accurate high-tech tool
makes it possible to directly visualize joint structures, detect early
and pre-disease states of OA, and assess the influence of potential risk
factors.
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The location of knee pain can help identify the problem.
Pain on the
front of the knee can be due to bursitis, arthritis, or softening of the
patella cartilage as in chondromalacia patella.
Pain on the sides of the
knee is commonly related to injuries to the collateral ligaments,
arthritis, or tears to the meniscuses.
Pain in the back of the knee can
be caused by arthritis or cysts, known as Baker’s cysts. Baker’s cysts
are an accumulation of joint fluid (synovial fluid) that forms behind
the knee.
Overall knee pain can be due to bursitis, arthritis, tears in
the ligaments, osteoarthritis of the joint, or infection.
Instability, or giving way, is also another common knee problem.
Instability is usually associated with damage or problems with the
meniscuses, collateral ligaments, or patella tracking.
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Taking advantage of this novel methodology, the
researchers studied the effect of physical activity, in various degrees
of intensity, frequency, and duration, on knee structures in a total of
257 healthy adults between the ages of 50 and 79, with no history of
knee injury or OA.
Their findings, presented in the October 2007 issue
of Arthritis Care & Research, suggest that exercise that is good for the
heart is also good for the knee.
Recruited from an established community-based
research population, the Melbourne Collaborative Cohort Study, subjects
all underwent MRI exams on the tibia bone and tibiofemoral joint of
their dominant knee—the one on the leg they first step forward when
walking.
MRI was used to assess cartilage defects and bone
marrow lesions, as well as measure cartilage volume, an indicator of
cartilage health and strength. Loss of knee cartilage is linked to
worsening knee symptoms in OA sufferers.
Subjects also answered specific questions regarding
their exercise and walking habits, as well as routine activity at home
and at work, to determine their level of physical activity in both the 6
months and 7 days prior to the study.
To create a baseline for each subject, past
information on weight, height, body mass index, and physical activity,
from questionnaires completed between 1990 and 1994, was obtained. Then,
the team performed a series of analyses and comparisons.
Among the notable findings, both baseline and
current vigorous physical activity— exercise that gets the heart pumping
and the body sweating—were associated with an increase in tibial
cartilage volume, free from cartilage defects.
What’s more, tibial cartilage volume increased with
frequency and duration of vigorous activity. Recent weight-bearing
exercise was also linked to increased tibial cartilage volume and
reduced cartilage defects. Finally, moderate physical activity,
including regular walking, was associated with a lower incidence of bone
marrow lesions.
“This is the first study to demonstrate a
potentially beneficial effect of walking on the reduction in the risk of
bone marrow lesions in the knee,” notes the study’s leading author, Dr.
Flavia M. Cicuttini.
“Bone marrow lesions have been associated with pain
and radiograph-defined progression of osteoarthritis, type II collagen
degradation, and loss of cartilage volume.”
Demonstrating a protective effect of past and
current vigorous physical activity on knee cartilage in healthy adults,
this study strongly supports the benefits of exercise for older
individuals at risk for OA.
Though both the intensity and duration of physical
activity had a significant positive impact on cartilage, the ideal
amount of physical activity for joint health remains unclear.
“Our data suggest that at least 20 minutes once per
week of activity sufficient to result in sweating or some shortness of
breath might be adequate. This is similar to, if not somewhat less than,
the recommendations for cardiovascular health,” Dr. Cicuttini observes.
Editor’s Notes:
Article: “Effect of Physical Activity on Articular
Knee Joint Structures in Community-Based Adults,” Tina L. Racunica,
Andrew J. Teichtahl, Yuanyuan Wang, Anita E. Wluka, Dallas R. English,
Graham G. Giles, Richard O’Sullivan, and Flavia M. Cicuttini, Arthritis
Care & Research, October 2007; (DOI: 10.1002/art.22990).
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Cross Section of Knee Joint
The
top illustration shows the cross section of a normal knee joint: a
crescent-shaped disk held in place by ligaments (the meniscus) reduces
friction during joint movement, while the membrane surrounding movable
joints (the synovium) secretes a lubricating fluid.
Below
that, the two illustrations on the left show the effect of rheumatoid
arthritis, in which the immune system attacks the body's own tissues:
the synovium becomes inflamed and thickened, and inflammation may later
spread to the cartilage and bone.
In the
two illustrations on the right, the effects of osteoarthritis are shown:
the cartilage structure begins losing its elasticity and the synovium
becomes inflamed. Inflammatory proteins and enzymes damage the cartilage
further. As cartilage breaks down, small pieces break off to form loose
bodies, explosing the underlying bone. The joint may then become
enlarged and distorted.
…More Information
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>>
Arthritis Care & Research
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Q&A About Knee Problems, National Institute of Arthritis and
Musculoskeletal and Skin Diseases
>>
More at MedlinePlus
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