Post by KenNiemann on Oct 27, 2006 2:18:38 GMT -5
Strength Training May Benefit Patients With Osteoarthritis CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Release Date: October 2, 2006; Valid for credit through October 2, 2007
--------------------------------------------------------------------------------
October 2, 2006 — During 30 months of strength training, patients with osteoarthritis (OA) maintained more strength and less joint space narrowing compared with those performing range of motion exercises, according to the results of a study reported in the October 15 issue of Arthritis Care & Research.
"Numerous studies have documented the symptomatic benefits of isometric and dynamic exercise for individuals with knee OA," write Alan E. Mikesky, MD, from the Indiana University-Purdue University in Indianapolis, and colleagues. "However, no studies have investigated whether quads strengthening exercises prevent incident radiographic changes or slow the progression of knee OA."
In this study, 221 older adults stratified by sex, presence of radiographic knee OA, and severity of knee pain were randomized to strength training or range of motion (ROM) exercises. Mean age was 69 years. For 12 weeks, patients exercised 3 times weekly (twice at a fitness facility and once at home). This was followed by transition to home-based exercise after 12 months. The investigators evaluated isokinetic lower extremity strength and highly standardized knee radiographs at baseline and 30 months.
During 30 months, subjects in both groups lost lower extremity strength, but the rate of loss was slower with strength training than with ROM exercises. Compared with ROM exercises, strength training was associated with decreased mean rate of joint space narrowing in OA knees by 26% (P = not significant). The frequency of knee OA progression in joint space narrowing consensus ratings was 18% in the strength training group and 28% in the ROM group (P = .094).
In knees that were radiographically normal at baseline, joint space narrowing of more than 0.50 mm was more common in strength training (34%) than in ROM (19%; P = .038) group. Incident joint space narrowing was not associated with exercise adherence, changes in quadriceps strength, or knee pain.
"The ST [strength training] group retained more strength and exhibited less frequent progressive JSN [joint space narrowing] over 30 months than the ROM group," the authors write. "The increase in incident JSN >.50 mm in ST is unexplained and requires confirmation."
Study limitations include the absence of concurrent data on radiographic outcomes; isotonic strength measurements not blinded to treatment group; differences in the results of isotonic testing and isokinetic testing possibly due to strength specificity; and limited study power.
"It is possible that the increased frequency of incident medial compartment JSN associated with strength training in this study reflects, in part, meniscal subluxation, which MRI [magnetic resonance imaging] studies have shown to precede the thinning of knee articular cartilage and to account for a significant proportion of cases of early radiographic JSN," the authors conclude. "In any event, this finding requires confirmation in future trials of resistance exercise programs for older adults, which should include serial standardized radiographic or MRI examinations to monitor possible adverse effects of lower extremity resistance training on articular cartilage in the knee."
The National Institutes of Health supported this study in part.
Arthritis Care Res. 2006;55:690-699.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe the effect of strength training compared with ROM exercises on lower leg strength.
Compare the effect of strength training vs ROM exercises on joint space narrowing in patients with knee OA.
Clinical Context
Knee OA is one of the strongest predictors of disability among diseases, and risk factors for knee OA include age, female sex, obesity, trauma, and quadriceps weakness. Loss of quadriceps strength may be prevented by strength training, which may in turn slow the progression of knee OA. Quadriceps weakness in the elderly can be reduced with strength training, which can also improve balance, risk for falls, walking speed, and stair climbing.
The current trial is a 30-month, randomized controlled trial examining the effects of lower extremity strength training with attention-controlled ROM exercises on the incidence and progression of knee OA in older adults.
Study Highlights
221 functionally independent adults older than 55 years with lower extremity muscle weakness with and without knee OA were included.
Exclusion criteria were inability to walk without assistance, amputation, heart disease, rheumatoid arthritis or connective tissue disease, and cognitive impairment.
Knee OA was defined by Kellgran and Lawrence criteria, and knee pain was determined to be present using a Likert scale and the Western Ontario and McMaster Universities OA Index (WOMAC).
Participants were randomized into a strength training and a ROM group after stratification into "OA/pain," "OA/no pain," "no OA/pain," and "no OA/no pain" groups.
Strength training was delivered at the National Institute for Fitness and Sport (NIFS) twice weekly and once weekly at home for 3 months, reducing to 2 sessions per month at the NIFS and other workouts at home for a total of 3 workouts per week.
Each workout consisted of warm-up; resistance training using leg presses, curls, seated chest presses, and back rows; and cool down.
Similar exercises were performed at home.
The ROM group had the same sequence but used flexibility exercises targeted at neck, shoulders, trunk, elbows, hips, knees, and ankles.
Attendance was monitored by a card check-in system.
Isotonic and isokinetic strength of the lower limbs were measured at baseline, 12, 24, and 40 months.
Primary outcomes were WOMAC score for knee pain, radiologic change (joint space narrowing and osteophytes), and secondary outcomes were Medical Outcomes Study Short Form General Health Survey score and depression.
Radiologic measures included minimum joint space width, rate of joint space narrowing, and osteophyte severity rated on a scale of 0 to 3 at 4 sites.
Mean age was 69 years, 58% were female, mean body mass index was 29 kg/m2, and 40% had grade 3 to 4 severity of knee OA.
Isokinetic quadriceps strength was greater at baseline in men whose knees were radiologically normal than in those with knee OA.
Only 70% completed the protocol during 30 months.
Of those who completed the protocol, adherence to the regimen was 48% in both groups at 12 weeks and 59% (standard training group) to 64% (ROM group) at 12 months.
Isotonic hamstring strength demonstrated increases in both men and women in the strength training group at 12 months, which were significantly greater than the ROM group.
Those with knee OA lost more lower extremity strength vs those without knee OA and those with severe knee pain lost more quadriceps strength than asymptomatic patients.
Isokinetic strength at 30 months was related positively to adherence to the exercise regimen schedule.
The strength training group with OA showed less progression of joint space narrowing for 30 months vs the ROM group.
In those without OA at baseline, joint space narrowing for 0.50 mm was more common in the strength training than in the ROM group (24% vs 19%; P = .038).
Strength training did not have an effect on knee pain.
Knee function showed a trend toward improvement in the strength training group vs the ROM group.
Depression scores worsened slightly in both groups during 30 months.
Pearls for Practice
Strength training of the lower extremity vs ROM exercises 3 times weekly in older patients is associated with more retention of quadriceps strength.
Strength training in patients with OA is associated with less frequent progression of joint space narrowing for 30 months compared with ROM exercises.
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Release Date: October 2, 2006; Valid for credit through October 2, 2007
--------------------------------------------------------------------------------
October 2, 2006 — During 30 months of strength training, patients with osteoarthritis (OA) maintained more strength and less joint space narrowing compared with those performing range of motion exercises, according to the results of a study reported in the October 15 issue of Arthritis Care & Research.
"Numerous studies have documented the symptomatic benefits of isometric and dynamic exercise for individuals with knee OA," write Alan E. Mikesky, MD, from the Indiana University-Purdue University in Indianapolis, and colleagues. "However, no studies have investigated whether quads strengthening exercises prevent incident radiographic changes or slow the progression of knee OA."
In this study, 221 older adults stratified by sex, presence of radiographic knee OA, and severity of knee pain were randomized to strength training or range of motion (ROM) exercises. Mean age was 69 years. For 12 weeks, patients exercised 3 times weekly (twice at a fitness facility and once at home). This was followed by transition to home-based exercise after 12 months. The investigators evaluated isokinetic lower extremity strength and highly standardized knee radiographs at baseline and 30 months.
During 30 months, subjects in both groups lost lower extremity strength, but the rate of loss was slower with strength training than with ROM exercises. Compared with ROM exercises, strength training was associated with decreased mean rate of joint space narrowing in OA knees by 26% (P = not significant). The frequency of knee OA progression in joint space narrowing consensus ratings was 18% in the strength training group and 28% in the ROM group (P = .094).
In knees that were radiographically normal at baseline, joint space narrowing of more than 0.50 mm was more common in strength training (34%) than in ROM (19%; P = .038) group. Incident joint space narrowing was not associated with exercise adherence, changes in quadriceps strength, or knee pain.
"The ST [strength training] group retained more strength and exhibited less frequent progressive JSN [joint space narrowing] over 30 months than the ROM group," the authors write. "The increase in incident JSN >.50 mm in ST is unexplained and requires confirmation."
Study limitations include the absence of concurrent data on radiographic outcomes; isotonic strength measurements not blinded to treatment group; differences in the results of isotonic testing and isokinetic testing possibly due to strength specificity; and limited study power.
"It is possible that the increased frequency of incident medial compartment JSN associated with strength training in this study reflects, in part, meniscal subluxation, which MRI [magnetic resonance imaging] studies have shown to precede the thinning of knee articular cartilage and to account for a significant proportion of cases of early radiographic JSN," the authors conclude. "In any event, this finding requires confirmation in future trials of resistance exercise programs for older adults, which should include serial standardized radiographic or MRI examinations to monitor possible adverse effects of lower extremity resistance training on articular cartilage in the knee."
The National Institutes of Health supported this study in part.
Arthritis Care Res. 2006;55:690-699.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe the effect of strength training compared with ROM exercises on lower leg strength.
Compare the effect of strength training vs ROM exercises on joint space narrowing in patients with knee OA.
Clinical Context
Knee OA is one of the strongest predictors of disability among diseases, and risk factors for knee OA include age, female sex, obesity, trauma, and quadriceps weakness. Loss of quadriceps strength may be prevented by strength training, which may in turn slow the progression of knee OA. Quadriceps weakness in the elderly can be reduced with strength training, which can also improve balance, risk for falls, walking speed, and stair climbing.
The current trial is a 30-month, randomized controlled trial examining the effects of lower extremity strength training with attention-controlled ROM exercises on the incidence and progression of knee OA in older adults.
Study Highlights
221 functionally independent adults older than 55 years with lower extremity muscle weakness with and without knee OA were included.
Exclusion criteria were inability to walk without assistance, amputation, heart disease, rheumatoid arthritis or connective tissue disease, and cognitive impairment.
Knee OA was defined by Kellgran and Lawrence criteria, and knee pain was determined to be present using a Likert scale and the Western Ontario and McMaster Universities OA Index (WOMAC).
Participants were randomized into a strength training and a ROM group after stratification into "OA/pain," "OA/no pain," "no OA/pain," and "no OA/no pain" groups.
Strength training was delivered at the National Institute for Fitness and Sport (NIFS) twice weekly and once weekly at home for 3 months, reducing to 2 sessions per month at the NIFS and other workouts at home for a total of 3 workouts per week.
Each workout consisted of warm-up; resistance training using leg presses, curls, seated chest presses, and back rows; and cool down.
Similar exercises were performed at home.
The ROM group had the same sequence but used flexibility exercises targeted at neck, shoulders, trunk, elbows, hips, knees, and ankles.
Attendance was monitored by a card check-in system.
Isotonic and isokinetic strength of the lower limbs were measured at baseline, 12, 24, and 40 months.
Primary outcomes were WOMAC score for knee pain, radiologic change (joint space narrowing and osteophytes), and secondary outcomes were Medical Outcomes Study Short Form General Health Survey score and depression.
Radiologic measures included minimum joint space width, rate of joint space narrowing, and osteophyte severity rated on a scale of 0 to 3 at 4 sites.
Mean age was 69 years, 58% were female, mean body mass index was 29 kg/m2, and 40% had grade 3 to 4 severity of knee OA.
Isokinetic quadriceps strength was greater at baseline in men whose knees were radiologically normal than in those with knee OA.
Only 70% completed the protocol during 30 months.
Of those who completed the protocol, adherence to the regimen was 48% in both groups at 12 weeks and 59% (standard training group) to 64% (ROM group) at 12 months.
Isotonic hamstring strength demonstrated increases in both men and women in the strength training group at 12 months, which were significantly greater than the ROM group.
Those with knee OA lost more lower extremity strength vs those without knee OA and those with severe knee pain lost more quadriceps strength than asymptomatic patients.
Isokinetic strength at 30 months was related positively to adherence to the exercise regimen schedule.
The strength training group with OA showed less progression of joint space narrowing for 30 months vs the ROM group.
In those without OA at baseline, joint space narrowing for 0.50 mm was more common in the strength training than in the ROM group (24% vs 19%; P = .038).
Strength training did not have an effect on knee pain.
Knee function showed a trend toward improvement in the strength training group vs the ROM group.
Depression scores worsened slightly in both groups during 30 months.
Pearls for Practice
Strength training of the lower extremity vs ROM exercises 3 times weekly in older patients is associated with more retention of quadriceps strength.
Strength training in patients with OA is associated with less frequent progression of joint space narrowing for 30 months compared with ROM exercises.
