By: Jean Johnson for Knee1Baby boomers in their late fifties might want to take heed. The Centers for Disease Control and Prevention (CDC) estimate that in 2001 21.4 million older people had physician-diagnosed osteoarthritis (OA), or just plain arthritis as most of us call it. But by 2030 when a boomer that is now 58 turns a rather overripe 82, that number is expected to increase to 41.4 million. Not all arthritis is in the knees, of course, but a significant number of cases are.
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The CDC encourages all those with arthritis to see their physician. The disease is not necessarily a part of aging and with proper care it can be managed. Three main types of exercises recommended by the U.S. Food and Drug Administration for those with osteoarthritis are:
Range-of-motion. Moving a joint as far as it will comfortably go and then stretching it a little further to increase and maintain joint mobility, decrease pain, and improve joint function. These can be done daily, or at least every other day.
Strengthening. Using muscles without moving joints to help increase muscle strength and stabilize weak joints. These can be done daily, or at least every other day, unless there is severe pain or swelling.
Endurance. Aerobic exercises such as walking, swimming and bicycling to strengthen the heart and lungs and increase stamina. These should be done for 20 to 30 minutes, three times a week, unless there is severe pain or swelling.
Knee1 recommends that anyone with arthritis see their physician prior to starting an exercise program. |
Worse, arthritis is the leading cause of disability among older adults, and when it strikes in the knees, disability can come to mean immobility. If the thought of 41 million baby boomers hobbling around on fragile knees makes you shudder, join Knee1 in exploring what science is increasingly telling us are good interventions we can put into place now for better health down the road.
The take-home message senior behavioral scientist at the CDC, Teresa J. Brady, PhD, wants to leave with us is that arthritis is not a normal part of aging we necessarily have to take in stride. She says that rather than reaching for the aspirin, we need to be dosing ourselves with moderate regular physical exercise like walking.
Knee Health Benefits from Regular, Moderate Exercise
Brady is simply reiterating what the Arthritis Foundation is presently recommending: regular exercise. But twenty years ago, it wasn’t the case. According to the U.S. Food and Drug Administration (FDA), as recently as the early 1980s “doctors advised exactly the opposite, fearing that activity would cause more damage and inflammation.” Now, however, the FDA states that “not exercising causes weak muscles, stiff joints, reduced mobility, and lost vitality, say rheumatologists, who routinely advise a balance of physical activity and rest.”
Clearly, those with osteoarthritis in their knees need to be cautious. Toward that end, the National Institutes of Health (NIH) advise that “the amount and form of exercise should depend on which joints are involved, the amount of inflammation, how stable the joints are, and whether a joint replacement procedure has been done. A skilled physician who is knowledgeable about the medical and rehabilitation needs of people with arthritis can, with a physical therapist, design an exercise plan for each patient.”
Current Research on Knees
As far as current research goes, a Swedish team used magnetic resonance imaging (MRI) to study cartilage changes in the knees of participants at high risk for osteoarthritis – patients who had surgical histories for degenerative meniscus tearing. Researchers Leif Dahlberg, MD, PhD, and Ewa M. Roos, PT, PhD looked at a small group, 45 people between age 35 and 50. Researchers randomly assigned 30 of those recruited to three one-hour aerobic and strength training sessions per week, for a duration of four months.
Both the participants’ perceived assessments of knee pain and stiffness, and MRI measurements of glycosaminoglycan in the knee cartilage evidenced improvement. “The study shows compositional changes in adult joint cartilage as a result of increased exercise, which confirms the observations made in prior animal studies but has not been previously shown in humans,” Dahlberg told Medical News Today.
Although Dahlberg and Roos acknowledged that given the small size and narrow focus, study results are preliminary, they nonetheless think that their data is strong enough to warrant serious consideration: “Exercise may have important implications for disease prevention in patients at risk of developing knee OA.”
A team at the Claude D. Pepper Older Americans Independence Center at Wake Forest University in Winston-Salem, North Carolina added dietary weight loss to the exercise equation and published results related to older adults with knee osteoarthritis in Arthritis Rheumatology in 2004.
According to principal investigator Stephen P. Messier, PhD, “The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.”
Indeed, the National Recreation and Park Association in collaboration with the US Department of Health and Human Services has gone on record under the rubric of Healthy People 2010. Their pitch is that “even though more than 300,000 people die each year in the United States from conditions related to dietary factors and an inactive lifestyle, many Americans still find it hard to get moving and to be even moderately active for the recommended 30 minutes a day for adults and 60 minutes for children.”
In sum, it’s more of the same. We need to keep our weight down. We need to stay active. We need to take more walks around the block – or down the street to the grocery store or coffee shop. But who wants to walk along gritty urban streets? Nobody it seems, and here’s where the trees come in.
Trees Sweeten the World
While the nation’s parks and recreation spaces are a focal point for Healthy People 2010, Richard Killingsworth, MPH, director of the Active Living by Design and associate research professor in the Department of Health and Behavior and Health Education at the University of North Carolina at Chapel Hill, wants us to think more in terms of our every day lives: how we might get more activity in just by going about our business.
“Unfortunately, physical activity has been engineered out of our daily lives,” Killingsworth told the Trust for Public Land. In our haste to pave paradise when we were moving from the farm to town in the late nineteenth and early twentieth centuries, we got a bit overzealous.
Kathleen Wolf, PhD, a research social scientist in urban forest environment and behavior at the University of Washington (UW), talked to us about the problem. “With all the concern about obesity and physical activity, the transportation industry is having to rethink how streets are designed because people want to walk to get physical activity,” she said. “So the research is starting to come out on how streets with trees on them affect this.
“The walk-ability of a community depends on the density of service nodes in a block, but it seems that the tree factor is part of that as well,” said Wolf. “Studies at the Texas Transportation Institute at Texas A&M found that parents who have school-age children are more inclined to encourage the kids to walk to school if the route is lined with trees.
“Also a team of graduate students at UW looked at residential neighborhoods that had grocery stores in walking distance. They compared streets that were tree-lined to those that were not and found that residents perceived that that distance was less if there was greening. So people may be more inclined to walk if they think it’s not as far.”
Plant a Street Tree?
If you’re inspired and want to be part of increasing what’s known as the urban canopy, there are a number of national and local organizations that offer help. The National Arbor Day Foundation promotes the planting and maintenance of urban forests at www.arborday.org. Also, most cities and towns have various groups that will assist homeowners and communities interested in adding the joys of the urban canopy to their environs.
