Weight training and cardiovascular exercise
may be just the ticket for patients who are
preparing for knee- or hip-replacement surgery,
a new study suggests.
Those patients who
took part in one-hour exercise regimens just
three times a week were 73 percent less likely
to be discharged to a rehabilitation center
after their surgery, researchers found.
Only 12 of 36 patients who took part in the
exercise had to enter the rehab centers, compared
to 23 of 43 patients who didn't exercise,
said study author Daniel Rooks, an assistant
professor of medicine at Harvard Medical School,
and Beth Israel
Deaconess Medical Center in Boston.
While the study is small, Rooks said, "The
benefits of exercise before surgery are very
clear. The more you can do for yourself physically
before surgery, the better off you are."
It's no secret that physically fit people
are better able to tolerate osteoarthritis,
Rooks said. "Their muscles and soft tissues
are stronger and better conditioned, which
helps stabilize the knee, protect the joints
and allow people with arthritis to move with
less discomfort."
But it was unclear how much value exercise
provides to people with severe arthritis who
face surgery. So, Rooks and his colleagues
enlisted patients who were preparing for either
hip- or knee-replacement surgery and divided
them into two groups.
One group took part in one-hour group exercise
regimens three times a week at a hospital-affiliated
fitness center. At first, participants performed
water exercises. Then they moved on to stationary
bikes, weight lifting (with both machines
and dumbbells) and abdominal strengthening
exercises. They also stretched.
"It is not unlike a program that you
or I would go through," Rooks said.
Even in a fairly brief time period -- six
weeks -- the exercise paid benefits for the
participants. "We saw that their level
of function stabilized and their pain stabilized
prior to surgery," Rooks said. "Those
who did not exercise, their function and pain
got worse."
The study results were published in the October
issue of Arthritis Care & Research.
Six weeks isn't enough time to boost muscle
strength by major amounts, Rooks said. But,
he added, it's possible that some of the benefits
came because participants "were just
feeling more confident and comfortable that
they could exert themselves without hurting
themselves."
Ultimately, the study shows that "just
because you have arthritis doesn't mean you
should not exercise, and if you have arthritis,
it's another reason you should begin exercising
or keep exercising," Rooks said.
Another study in the same issue of Arthritis
Care & Research examined whether weight
training aimed at the quadriceps -- the group
of muscles along the front of the thigh --
could help patients with osteoarthritis in
their knees.
Researchers led by Alan Mikesky, a professor
at Indiana University's department of physical
education, recruited people with knee arthritis
and people without it and told them to take
part in weight-lifting or "range-of-motion"
exercises. Of 221 subjects, 174 stayed in
the study throughout the entire 30 months.
The researchers found that both groups lost
strength in their legs, a finding that was
"difficult to explain," but the
loss was slower in those who lifted weights,
the researchers said.
Also, those with arthritis didn't report
any decrease in knee pain, and there were
conflicting reports about whether weight training
might do something positive by helping prevent
the narrowing of space between joints.
The researchers are calling for more studies
to clarify matters.
Still, other recent research has suggested
that exercise can reduce disability in people
with arthritis, said Dorothy Dunlop, research
associate professor at Northwestern University's
Institute for Healthcare Research. "In
addition, physical activity has broad health
benefits: It improves endurance, reduces depression
and is linked to reduced premature mortality,"
she said.
Even so, a 2001 federal survey found that
24 percent of arthritis patients took part
in no moderate-intensity physical activity,
Dunlop said.
"The Arthritis Foundation and the Centers
for Disease Control have designed programs
that provide safe and beneficial physical
activities for persons with arthritis,"
she said. "The opportunities are there.
The benefits of physical activity are real.
The consequences of inactivity are serious.
It is time for persons with arthritis to get
moving."
