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Exercise and disability in older people with OA

 

Clinical bottom line

Aerobic and resistance exercise can reduce the incidence of disability in activities of daily living in older people with osteoarthritis of the knee. More exercise may mean lower disability.


Reference

BW Penninx et al. Physical exercise and the prevention of disability in activity of daily living in older persons with osteoarthritis. Archives of Internal Medicine 2001 161: 2309-2316.

Study

This was a randomised single-blind trial. People with knee osteoarthritis aged 60 years or older with pain in the knee on most days of the month and some disability in climbing stairs or walking were randomised to an attention control programme, a resistance exercise programme or to an aerobic exercise programme.

Self-reported disability was assessed every three months during the 18 month follow up. Patients were seen at three, nine, and 18 months. A 30-item physical disability questionnaire was developed assessing difficulty in tasks on mobility, transferring form bed to chair, and so on.

Results

There were 250 participants free of disability of activities of daily living at baseline, with a mean age of 69 years, and 68% of whom were women. Compliance with exercise declined over time, with 85% compliant during first three months, dropping to 54% at 12 to 18 months.

Over the 18 months, 105 of 250 persons (42%) developed disability of activities of daily living. This was significantly higher in the participants in the attention control group (53% cumulative incidence) than in either of the exercise groups (about 37%; Figure 1).

Figure 1: 18-month cumulative incidence of disability of activities of daily living


Persons participating in either a resistance or aerobic exercise programme had a significantly higher probability of remaining free of disability of activities of daily living. The combined relative risk was 0.57 (95% confidence interval 0.38 to 0.85). In both the resistance group and the aerobic group, those who had the highest compliance with exercise were most likely to remain free of disability of activities of daily living.

Comment

This was a selected group of older people with knee arthritis. Exercise meant that they much more likely to remain free of disability of activities of daily living, and therefore to maintain their independence. Independence is important to older people, and this link between exercise before disability to prevent disability and dependence is a major public health message.