Knee Arthritis, Is Exercise Making it Worse?
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Once again, I have been scouring the internet for recent research on exercise to see what is hot 🔥 and relevant for those of us over 50, 60, 70, 80, and beyond. This week, let's talk about knee arthritis and ageism.
First, I want to congratulate you for participating in sports in your younger years, this was most likely beneficial to your health today, including your joint health. Unless you were a high-level elite athlete, your risk of developing osteoarthritis is the same as someone who has been sedentary. In this review article from 2016, the authors concluded:
"Moderate daily recreational or sport activities, whatever the type of sport,
are not a consistent risk factor for clinical or radiographic knee/hip OA."
Stop beating yourself up for running, or playing tennis, or whatever your sport was. You were active, and you are better off for it. The authors point out that physical activity helps more than it harms. The good stuff you get from physical activity:
"soft-tissue extensibility, blood flow, and synovial fluid mobility,
normal joint range of motion and ... essential nutrients to the cartilage matrix."
These are all GOOD things!
But some of you may have arthritis nonetheless. What should you do about it now?
In the September 2023 issue of the Journal of Geriatric Physical Therapy, a systematic review and meta-analysis, addressed this question. Should someone continue resistance training or add it in the presence of knee osteoarthritis?
The short answer is YES.
The average age of the subjects in the review was 64.2 years. The resistance training programs varied in length from 4-120 weeks, with a frequency between 2-7 times per week. Because it was a review, there was not a consistent exercise intervention. Some studies used weight machines, others used theraband or ankle weights. All of the studies worked to strengthen the quadriceps and hamstring muscle groups in some way.
The conclusions - Resistance training 2 times per week, above 50% of your one rep max, and consistently done beyond 4 weeks can help knee symptoms, function, and strength.
If you have not been strengthening your knees but would like to start, I have these two exercises for you.
The Straight Leg Raise, and the Quad Set. These are particularly helpful to know before any type of surgery, or after surgery, or to stay strong when standing exercises don't feel great. I am particularly fond on the leg press machine if you have access to one.
If your knees are feeling good but you need to be sure to keep your strength, start working on higher-demand exercises like the squat.
Now I want to touch on the subject of ageism.
Definition from the American Psychological Association: Ageism is defined as discrimination against older people because of negative and inaccurate stereotypes—and it’s so ingrained in our culture that we often don’t even notice.
A recent comment in my Osteoporosis and Osteopenia Exercise group got me thinking about how important it is to keep pushing back on the stereotypes of aging. This sentence from this study in JAMA in 2022, really struck me:
Associating poor health with old age may be the most deeply rooted aging stereotype, despite evidence to the contrary (for example, 82.3% of participants in the current study rated their physical health as good or better).
I want to list a few examples of the questions that were asked in this study to determine if the participants were experiencing everyday ageism (you can read the whole list here):
I hear, see or read jokes about old age, aging, or older adults
I hear, see or read things suggesting that older adults and aging are unattractive or undesirable
People insist on helping me with things I can do on my own
People assume I have difficulty hearing or seeing things
Having health problems is a part of getting older
As a physical therapist, I can tell you I have been yelled at and called names many times for pushing older clients too hard by their well-meaning relatives. It started during my very first clinical rotation, right up to today in my Facebook group - MY Facebook group, about exercise! The irony.
Let's end ageism.
✅ Stay strong and retire active,
Andrea Trombley PT, DPT
Addendum: This article by orthopedic surgeon Howard Luks backs up all I said here! Three Words that Cause Harm: "Bone on Bone"
References
Allen, J. O., Solway, E., Kirch, M., Singer, D., Kullgren, J. T., Moïse, V., & Malani, P. N. (2022). Experiences of Everyday Ageism and the Health of Older US Adults. JAMA network open, 5(6), e2217240. https://doi.org/10.1001/jamanetworkopen.2022.17240
Lefèvre-Colau, M. M., Nguyen, C., Haddad, R., Delamarche, P., Paris, G., Palazzo, C., Poiraudeau, S., Rannou, F., & Roren, A. (2016). Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?. Annals of physical and rehabilitation medicine, 59(3), 196–206. https://doi.org/10.1016/j.rehab.2016.02.007
Wang, Huan PhD1; Ma, Baoan MD1; Wang, Guotuan PhD2; Wang, Pu PhD1; Long, Hua PhD1; Niu, Shun PhD1; Dong, Chuan PhD1; Zhang, Hongtao PhD1; Zhao, Zhen PhD1; Ma, Qiong PhD1; Hsu, Chihw-Wen PhD3,4; Yang, Yong PhD5; Wei, Jianshe PhD2,6. Dose-Response Relationships of Resistance Training in Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Journal of Geriatric Physical Therapy ():10.1519/JPT.0000000000000394, September 29, 2023. | DOI: 10.1519/JPT.0000000000000394