Exercise as it relates to Disease/Effect of resistance training on knee osteoarthritis in the elderly

What is Osteoarthritis?
Osteoarthritis is a range of musculoskeletal conditions that result in both a structural and functional failure of joints1. Following failure of the joint, there is a loss of cartilage and a degeneration of the joint. This progression may result in pain and disability.2 Any synovial joint in the body may be susceptible to Osteoarthritis but is most common in the hips, hands and knees2.

Knee Osteoarthritis
Osteoarthritis may affect the entire knee joint which may lead to3:
 * Decreased quality of life;
 * High levels of pain;
 * Decreased physical function;
 * Decreased movement efficiency in the lower limb;
 * Problems performing everyday tasks, such as getting out of a chair.

What are the risk factors associated with Knee Osteoarthritis?
Research has shown a relationship between knee Osteoarthritis and the following3:


 * Lower education levels;
 * Increasing age;
 * Physical inactivity;
 * High Blood Pressure;
 * Obesity;
 * Manual occupation;
 * Female gender;
 * Genetics
 * Previous knee trauma or knee surgery.

What is the Prevalence of Knee Osteoarthritis?
Knee Osteoarthritis is one of the most common musculoskeletal diseases worldwide. In the elderly, it is the leading cause of disability4. Knee Osteoarthritis affects approximately 6% of adults aged 30 years and 10% of people aged over 65 years worldwide3. Research suggests that as population groups age, then the incidence of Osteoarthritis will increase and by 2020 current figures are expected to double6.

Are there any interventions to improving quality of life for those suffering from Knee Osteoarthritis?
While there is no known cure for knee Osteoarthritis, the main focus of treatment is to improve joint function and mobility, decrease pain and slow the progression of the disease.5. There are three categories of interventions:


 * Pharmaceuticals;
 * Therapeutic – such as exercise and rehabilitation;
 * Surgical.

Resistance Training and Knee Osteoarthritis
Research has shown there are benefits to the elderly and patients suffering from knee osteoarthritis that participate in a resistance training programs. Some benefits include5:


 * Decrease in pain;
 * Increase in joint strength;
 * Increase in physical function;
 * Increase in self confidence
 * Increase in perceived physical function;
 * Increase in social interaction.

Recommendations – Resistance training
The following are a list of recommendations for an individual with Knee Osteoarthritis, starting or participating in a resistance regimen:


 * Although further research needs to be conducted to determine the best type of resistance training, the use of elastic bands may be the best form of resistance training for patients suffering from Osteoarthritis;
 * A resistance program needs to be individualised;
 * At least three times per week1;
 * Duration of session varies dependent on individual2;
 * Supervised rather than home exercises3.

Precautions
Although research has shown it is safe to participate in resistance training while suffering from osteoarthritis3, the following precautions should be taken:


 * Clearance from doctor before participating;
 * Keep GP informed of training program;
 * Cease any exercises that cause pain.

Conclusion
Knee Osteoarthritis especially in the elderly causes large levels of pain and decreases physical function in the knee joint. This leads to an inability to perform daily tasks which decreases the patients quality of life. Interventions such as resistance exercise when performed correctly and safely can slow the progression of the disease, improve pain levels and improve physical function leading to many physical and quality of life benefits.

Reference List
1.    Hunter, D. J. & Eckstein, F. (2009). Exercise and osteoarthritis. Journal of Anatomy. 214(2):197-207. Sited: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667877/?tool=pmcentrez 2. 	Guccione, A.A. et al (1994) The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. American Journal of Public Health. 84(3): 351-358) Sited: http://www.ncbi.nlm.nih.gov/pubmed/8129049

3. 	Hunter, D. J. & Eckstein, F. (2009). Exercise and osteoarthritis. Journal of Anatomy. 214(2):197-207. Sited: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667877/?tool=pmcentrez

4.	Zhang, Yuqing et al (2001) Comparison of the Prevalence of Knee Osteoarthritis Between Elderly Chinese Population in Beijing and Whites in the United States. Arthritis & Rheumatism 44(9):2065-2071. Sited: http://onlinelibrary.wiley.com/doi/10.1002/1529-0131(200109)44:9%3C2065::AID-ART356%3E3.0.CO;2-Z/pdf

5.	Valderrabano, V. & Steiger, C. (2011). Treatment and prevention of osteoarthritis through exercise and sports. Journal of Aging Research. 374653. Sited: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004403/?tool=pmcentrez

6.     Badley E, DesMeules M. Arthritis in Canada: an Ongoing Challenge. Ottawa: Health Canada; 2003. Sited: http://web.archive.org/web/20050514011727/http://www.phac-aspc.gc.ca/publicat/ac/pdf/ac_e.pdf