Now there's scientific proof that exercise can be a safe and effective treatment option for knee osteoarthritis - good news for the millions of disabled Americans suffering from this degenerative joint disease. A recent clinical study, funded by the National Institute on Aging (NIA), suggests that people with osteoarthritis of the knee who exercise in moderation have less pain, reduced disability, and improved physical performance.
"In the past, opinion was divided as to whether exercise or rest was the better treatment for osteoarthritis. This study clearly comes down on the side of exercise," says Stanley Slater, M.D., deputy associate director of the NIA Geriatrics Program.
The Fitness Arthritis and Seniors Trial (FAST) results compared improvement measurements in people who participated in either a moderate intensity aerobic exercise training program or a moderate intensity resistance exercise training program with a health education program. The results showed a modest but consistent improvement in pain relief, disability, and physical performance for those who participated in the aerobic and resistance training programs compared to the control group. The results are published in the January 1, 1997, issue of the Journal of the American Medical Association (JAMA).
The aerobic training was divided into a 3-month walking program on an indoor track with a trained exercise leader followed by a 15-month walking program in the home environment designed by the exercise leader. Participants exercised for 1 hour, which included warm-up calisthenics and stretching, three times a week during each phase. The resistance training program consisted of a 3-month facility-based program followed by a 15-month home-based program. Dumbbells and cuff weights were used to strengthen major muscles in both the upper and lower body. The comparison group attended monthly 1 1/2-hour health education sessions led by a trained nurse. The program educated participants about osteoarthritis and the benefits of physical activity and exercise, and provided social interaction.
A group of 439 people age 60 and over with knee osteoarthritis and self-reported disability took part in the study, making the study unique in terms of the large numbers of participants, their diversity, and the fact that many were age 70 and up. The trial lasted 18 months and took place at 2 clinical centers: the University of Tennessee, Memphis, and Wake Forest University, Winston-Salem, NC.
"The findings are significant because they show that exercise over a long period of time is safe as well as beneficial for older people with knee osteoarthritis - they get relief from arthritis symptoms plus all the other health benefits of exercise. We hope the study will be a good model for people with other chronic illnesses and conditions," says principal investigator Walter H. Ettinger, Jr., M.D., Internal Medicine and Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University.
According to William B. Applegate, M.D., professor of Preventive Medicine, University of Tennessee, Memphis, "the findings are also important because heretofore most experts thought resistance exercise was more beneficial than aerobic exercise in patients with knee osteoarthritis. FAST indicates that both types of regimens are effective."
To get maximum health benefits, exercise has to be continued over a long period of time,but nationwide older people have a high dropout rate from exercise programs. Although the compliance rate was 68 percent in the aerobic training group and 70 percent in the resistance training group in this study, special attention is needed to get older, sedentary people to exercise and then to continue to exercise. Investigators suggest that another logical step would be a trial to determine if the combination of exercise and weight loss alters the course of osteoarthritis - something which exercise alone does not appear to do.
The Claude D. Pepper Older Americans Independence Center of Wake Forest University provided the support for this study through a grant from the NIA. Wake Forest is one of 10 Claude D. Pepper Older Americans Independence Centers throughout the country, authorized by Congress in 1990 to design and conduct research into diseases and aging processes that affect older people and their ability to live independently.
The NIA, a component of the National Institutes of Health, leads the Federal effort in supporting and conducting biomedical, social, and behavioral research and training related to aging and the special needs of older people.