Exercise slows pain progression, functional decline in elderly arthritis patients

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Exercise slows pain progression, functional decline in elderly

arthritis patients



Oct 3, 2005

Janis



Palo Alto, CA and Chicago, IL - The long-term practice of vigorous

exercise regimens such as running can significantly slow aging-

related increases in musculoskeletal pain in older adults, and older

arthritis patients who maintain a regular exercise program might

reduce functional decline by as much as 32%, according to a pair of

studies.

Dr Bonnie Bruce (Stanford University, Palo Alto, CA) reports in a

paper published September 19, 2005 in Arthritis Research & Therapy

that older adults who averaged about five hours of vigorous exercise

per week reported about 25% less musculoskeletal pain than more

sedentary subjects [1]. Dr Dorothy D Dunlop (Northwestern University,

Chicago, IL) finds even more striking benefits of exercise in older

adults with arthritis. She reports in Arthritis & Rheumatism that

lack of regular vigorous physical activity almost doubled the odds of

functional decline over a two-year period in arthritis patients over

age 65 [2].



" High vs low levels of physical activity protect against disability

progression in adults reporting arthritis. "

" It is well known that physical activity improves health. That

evidence led to the US surgeon general's physical-activity

recommendations. However, whether or not physical activity is able to

reduce disability—a major driver of healthcare costs—is an open

question, " Dunlop tells rheumawire. The study her group conducted

" directly addresses this question for persons with arthritis, " she

says. " These findings from a longitudinal survey of a national sample

by the National Institute of Arthritis and Musculoskeletal and Skin

Diseases and conducted by the University of Michigan show that high

vs low levels of physical activity protect against disability

progression in adults reporting arthritis. "

Lack of exercise speeds functional decline in arthritis patients

Dunlop et al looked at the relation between vigorous activity and

functional decline in older adults with arthritis. This study

analyzed two-year longitudinal data from a cohort of 5715 adults ages

65 or older from a national probability sample (the 1998 Health and

Retirement Study). The analysis included all patients who answered

" yes " to the question, " Have you ever had or has a doctor ever told

you that you have arthritis or rheumatism? "

The definition of function was based on ability to perform basic

activities of daily living (ADL). The investigators used a multiple

logistic regression model to estimate the association between

functional decline and a variety of potential risk factors.

" Because some people with arthritis may be less capable of physical

activity, we also looked at this question within subgroups of people

defined by the number of physical limitations reported. Within each

group, those engaged in higher levels of physical activity were less

likely to experience disability progression than their less active

peers. The benefit was greatest for those who should be most capable—

the subgroup reporting no physical limitations. This is important

information to promote the importance of ongoing public-health

efforts (eg, by the Centers for Disease Control and the Arthritis

Foundation) to increase physical activity for persons with

arthritis, " Dunlop says.

In the other study, Bruce and colleagues Dr F Fries (Stanford

University) and Dr Deborah P Lubeck (Genentech, South San Francisco)

conducted a prospective, longitudinal study in members of a running

club (n=492) and in community controls (n=374). Subjects were

followed for six years and were categorized both as runners'

association members vs community controls and as ever runners

( " runners, " n=565) and never runners ( " controls, " n=301), to include

those who had been runners but stopped. Subjects were surveyed with

yearly questionnaires and visual-analog-scale (VAS) pain measures.

As might be expected, at baseline the runners were significantly

younger (62 vs 66 years, p<0.05), slimmer (BMI 23.0 vs 24.3, p<0.05),

and less likely to have arthritis (35% vs 43%, p<0.05). Over the

course of the study, the runners averaged more exercise per week (291

minutes vs 120 minutes, p<0.05) and also had more fractures (52% vs

48%, p>0.05). The runners were also less likely to be smokers.

Over the study period, the runners' mean VAS pain scores (adjusted

for group, gender, and baseline BMI) were significantly lower than

those of the controls (p<0.01). " Pain scores were consistently about

25% less in the exercising group throughout the period of

observation, " the authors write.

" Our study adds to the abundance of evidence that being physically

active over the long term contributes to better health outcomes, in

this case reduced pain, but it does not provide insight into

mechanisms. These might include endorphin release, increased

resistance to musculoskeletal injury, increased musculoskeletal

strength, psychologically based increase in pain threshold, or other

psychological mechanisms, " Bruce tells rheumawire.

The researchers also tested the extent to which exercise and pain

were affected by increasing age. Their data show that, particularly

after age 60, both male and female controls had steady increases in

VAS scores, while runners had slower rates of increased pain. These

trends did not reach statistical significance.

One of the researchers' concerns had been the possibility that years

of running or similar vigorous exercise might actually increase pain.

They note, " If running creates damage through accumulated trauma,

then runners with about 10-fold the amount of exposure to such high

trauma should have increased pain over time, and any initial

differences due to self-selection should narrow as the study

progresses. " No such pain increases were observed.

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