Healthy Aging

Active with Osteoarthritis!
by Chelsey Crandell

To promote the positive life effects that physical activity has in the management of osteoarthritis in the elderly population I will be considering the development of the disease, its process, and its associated symptoms and complications that exercise can potentially relieve.

Arthritis is an encompassing term referring to disease of the body’s synovial joints involving articular cartilage damage (Spirduso, Francis & MacRae, 2005). Osteoarthritis, (the most common form of arthritis) is a frequent chronic disease and is the most common chronic joint disease. Just as any mechanical systems wears down over time, the normal aging of the body’s joints (more specifically the articular cartilage) begins to wear early in adult life and progresses further from then on (Prentice, 2006). The articular cartilage becomes less effective as a shock absorber and as lubricated surface therefore irreversible degenerative changes in the joint occurs. This disease process can affect all joints but usually affects those that are weight bearing such as hips and knees and often causes considerable pain, discomfort and stiffness (Moore & Dalley, 2006).

Also known as degenerative joint disease, osteoarthritis significantly disables the functionality and independence of as many as 50% of the population over the age of 60 years and 85% of the population over 75 years (Spirduso et al, 2005). It has more simply been stated that virtually everyone over 60 years of life displays signs of this painful degenerative condition in at least one of their body’s joints (Pedersen & Saltin, 2005). Osteoarthritis has become a major problem in terms of maintaining independence in later years as the effects can be physically debilitating, creating difficulty for activities of daily living such as walking, getting in and out of the bath tub and even simple household tasks (Lin, Davey & Cochrane, 2000).

Osteoarthritis is not a directly fatal disease but it does happen to be incurable (Nieman, 2007) therefore effective treatments are continuously being tested and sought after.

Successful management of this degenerative disease includes education, therapeutic modalities, medication and the implementation of exercise (Spirduso et al, 2005) which will be of utmost focus.

Unfortunately, the majority of those affected with osteoarthritis are reported as physically inactive. This lifestyle is shown to contribute to a decline in physical functioning along with an increased risk for unnecessary diseases such as heart disease, hypertension and diabetes mellitus (Fontaine & Andersen, 2004).

In order to prevent further development of chronic disease we must promote physical activity for those currently dealing with osteoarthritis and as well for the majority of our population that is highly susceptible to this degeneration of synovial joints.

Risk factors Associated with Osteoarthritis Development

Increasing age is the most prevalent and non-modifiable risk factor for osteoarthritis development (Spirduso et al, 2005).Increases in occurrence develops in woman after onset of menopause (after 40 years of age) and later in men (50 years of age) (Spirduso et al, 2005). Additional risk factors for development of osteoarthritis include Caucasian ethnicity, (Neiman, 2007) high body fat mass and muscular weakness leading to reduced joint proprioception and/or stability (Spirduso et al, 2005). Previous demanding long-term physical activity or intense sporting activities throughout one’s life could also lead to an increase in susceptibility of the degeneration of joints, however, it is imperative to understand that moderate amounts of physical activity do not increase risk for osteoarthritic conditions (Spirduso et al, 2005).

Benefits of Exercise

Research supports that consistent approach to exercise can improve overall quality of life and independence in those dealing with osteoarthritis (Marks & Allegrante, 2005). More specifically, exercise reduces the debilitating effects that are linked to osteoarthritis without increasing further joint dysfunction or amplifying pain (Marks & Allegrante, 2005). Several studies have revealed a beneficial effect in the relief of pain, (Kettunen & Kujala, 2004) a decrease in stiffness as well as a decrease in joint swelling which can lead to further improvements in joint’s range of motion, stability and strength (Marks & Allegrante, 2005). By increasing the stability of the joint through progressively strengthening the muscles surrounding the osteoarthritis- affected joint, further progression of the disease can be halted (Pedersen & Saltin, 2005.) Stability gains are also an important factor in postural control and balance as improvements in these components play a role in the reduction of falls for those at risk (Spirduso, Francis & MacRae, 2005).

Keeping the body physically active also has the ability to reduce the amount of medication required, decrease the risk of functional dependency or burden of additional chronic diseases that have potential to affect those with arthritis. Examples of these conditions could include diabetes mellitus and hypertension (Fontaine & Andersen, 2004).

Healthy weight loss can be significantly beneficial in enabling management of osteoarthritis and often comes hand in hand with increased activity, especially found with addition of endurance exercise (Pedersen & Saltin, 2005).

The physical benefits are hopefully convincing enough, however there are even more pros we can add to the list which promote a healthy mind. An active body influences decreases in anxiety, depression and fatigue along with improvements in sleep patterns, stress control, socialization and overall life quality (Marks & Allegrante, 2005).

Although physical activity proves to be a positive action, we must be aware of the potential adverse effects that can accompany excessive or inappropriate exercise doses. Signs of pain, joint damage, injury to muscles or tendons and extensive fatigue are all cues that may be hinting towards modifying of activity type and/or intensity (Marks & Allegrante, 2005).

Exercise Suggestions

There is only one way to gain these benefits of activity and that is to be active! Exercise should be enjoyable, uncomplicated and directed towards benefiting individual’s needs, beliefs and personal goals (Marks & Allegrante, 2005).

Activities should be simplistic and practical for the individual in order to effectively reach the primary goal of progressively strengthening all muscle groups including those surrounding the affected joints (Pedersen& Saltin, 2005).

Both dynamic (moving) and isometric (static) exercises have both been shown to be effective in developing strength and improving coordination and overall functionality (Marks & Allegrante, 2005). Endurance training doesn’t seem to have the same impact in respect to direct effects on the joints, although it does positively impact other physical health aspects in the prevention of disease (Marks & Allegrante, 2005).

To avoid potential injury and optimize effects of the exercises, initial or continuous monitoring from a therapist other exercise professional is recommended (Pedersen& Saltin, 2005). If further assistance is wanted or needed to protect joints, devices such as canes, walkers and prosthetics may be useful during activity (Marks & Allegrante, 2005). It may also be helpful with the control of pain to apply heat to the affected joints prior to exercise followed by cold application post exercise (Marks & Allegrante, 2005).

A ten minute warm up with minimal pressure application but movement of all joints is recommended at the commencing of an exercise session. Shorter more frequent exercise intervals are more likely to be better tolerated than longer less reoccurring sessions. As well, to directly affect disease, it is beneficial to execute shorter sessions several times weekly for at least several months (Marks & Allegrante, 2005).

There is a wide variety of exercise or exercise classes in which osteoarthritic individuals have the option to participate in. Bicycling, walking, swimming and water aerobics are excellent opportunities for low impact activity that reduce the percussion to joints (Pedersen& Saltin, 2005). These activities are diverse as they take place in various environments or an activity such as walking can be carry out nearly in any environment either indoors such as a inside track or in safe outdoor environments. As well, the above mentioned activities can either be effectively performed individually, with or without a therapist as well as in a group based setting (Pedersen& Saltin, 2005). Strengthening exercises that require minimal equipment such as elastic resistance bands can be effectively be performed in the comfort of one’s home (Marks & Allegrante, 2005).

Factors affecting choice of exercise for people with osteoarthritis include; age, extend of disease, muscle-strength and muscle endurance capacity, joint range of motion, extent of degeneration, degree of pain and/or inflammation, aerobic capacity, balance, use of assistive devices, time and accessible resources (Marks & Allegrante, 2005).

Adherence

One of the major obstacles in developing an active lifestyle is not the activity itself, rather maintaining consistency of carrying out that activity. Many individuals have the belief that exercise will increase their level of pain and fatigue and/or aggravate their osteoarthritis (Andersen, 2004) whereas evidence states the contrary. Those who adhere to exercise have reported improved quality of life as well as greater self-efficacy when compared to those that had ceased to exercise (Marks & Allegrante, 2005). Scores related to pain and strength have also shown greater improvement in those who exhibit higher rates of adherence (Marks & Allegrante, 2005).

Unfortunately there is a lack of adequately designed studies to further support the long-term effects of exercise in people with osteoarthritis. With that said, by looking at the vast amount of positive evidence found with short-term exercise we can be lead to safely presume that long-term adherence is likely to redeem the same and perhaps more prominent health outcomes (Marks & Allegrante, 2005). In addition, failing to maintain exercise can result in an even more rapid degeneration of joint materials leaving the opportunity for pain and inflammation to walk right, potentially pushing the once increased sense of well-being out (Marks & Allegrante, 2005).

Despite the countless exercise benefits and consequences derived from lack of compliance, many of those with osteoarthritis fail to adhere to physical activity. Due to this fact we must consider the possible factors that cause this in order to attempt to modify behavior in the direction towards consistent activity. Personal, social as well as environmental aspects of life each play a significant role in determining the likeliness of adherence to activity. Having self-efficacy, determination and knowledge to confidently perform activity are believed to positively correlate with adherence (Marks & Allegrante, 2005). Having a social support system such as family or participating in group activities are great motivators for sustaining exercise. High compliance and low dropout rates are especially found within exercise group settings as they often provide both a supportive and socially beneficial environment (Marks & Allegrante, 2005). Individuals are able to confide in others with opportunity for group cohesion, feedback, problem solving (Marks & Allegrante, 2005) and most importantly, enjoyment, which in the long run, no matter the age, determines whether one is to stick to a program or not.

Conclusion

Although more research is still needed for determining the optimal type and dosage of exercise for individuals at different stages of the joint deteriorating disease (Kettunen & Kujala, 2004), international consensus is that all forms of osteoarthritis should be treated with physical activity (Pedersen& Saltin, 2005).

With the shockingly high rates of osteoarthritis within the aging population it is imperative that attempts are made to create awareness of the beneficial effects exercise has on improving life quality. Even more critical are the ideas and suggestions made to motivate implementation and adherence to a physically active intervention (Andersen, 2004). As the author Liane Cardes one quoted, “Continuous effort-not strength or intelligence-is the key to unlocking our potential” (Jerome, 2007).

References

Jerome M. (2007). The Complete Runner’s Day-by-Day Log and Calendar (30 th ed.). The Random House Inc. New York, NY.

Nieman , D.C. (2007). Exercise Testing and Prescription: a health-related approach. (6 th ed.). (pp.639,645-646) The McGraw-Hill Companies, Inc

Prentice, W.E. (2006). Arnheim’s Principles of Athletic Training: A Competency- Based Approach . (pp. 260) McGraw-Hill Companies, Inc. New York, NY.

Moore , K.L., Dalley, D.F. (2006). Clinically Oriented Anatomy (5 th ed.). (pp.30, 715). Lippincott Williams & Wilkins. Philadelphia, PA.

Pedersen, B.K., Saltin, B. (2006). Evidence for prescribing exercise as theapy in chronic disease. Scandinavian Journal of Medicine & Science in Sports, 16: 3-30.

Marks, R., Allegrante, J.P. (2005). Chronic Osteoarthritis and Adherence to Exercise: A Review of the Literature. Journal of Aging and Physical Activity, 13: 434-460.

Spirduso, W.W., Francis, K.L., MacRae, P.G. (2005). Physical Dimensions of Aging (2 nd ed.). (pp 80-82). Human Kinetics. Champaign, IL.

Fpmtaome, K.R., Andersen, R.E. (2004). How Active Are Adults With Arthritis?. The American Journal of Medicine & Sports, May/June: 146-147.

Kettunen, J.A., Kujala, U.M. (2004). Exercise therapy for people with rheumatoid arthritis and osteoarthritis. Scandinavian Journal of Medicine & Science in Sports, 14: 138-141.

Lin, Y.C, Davey, R.C, Cochrane, T. (2001). Tests for physical function of the elderly with knee and hip osteoarthritis. Scandinavian Journal of Medicine & Science in Sports, 11: 280-286.