Work Group recommendations: 2002 Exercise and Physical Activity Conference, St Louis, Missouri.
Explore the source record for details and available documents.
Arthritis↗
Biomedical subjects
Leena Sharma
Publications and source records attributed to Leena Sharma.
Quadriceps strength and osteoarthritis progression in malaligned and lax knees.
BACKGROUND: Quadriceps muscle strengthening is a common goal in the management of knee osteoarthritis. In healthy knees, strength protects against new osteoarthritis. In arthritic knees, greater strength may protect joints and thereby delay osteoarthritis progression. Alternatively, in certain joint environments, such as malalignment or laxity, greater strength may translate into damaging joint reaction forces. The relationship between quadriceps strength and progression of knee osteoarthritis may differ according to these factors. OBJECTIVE: To determine whether greater quadriceps strength is associated with greater probability of tibiofemoral osteoarthritis progression in malaligned knees and in high-laxity knees. DESIGN: Prospective, longitudinal cohort study. SETTING: Academic medical center. PARTICIPANTS: 237 persons with primary knee osteoarthritis, definite tibiofemoral osteophytes, and at least some difficulty with knee-requiring activity. Two hundred thirty completed the 18-month evaluation. The current study primarily involved those without advanced osteoarthritis in either knee (n = 171). MEASUREMENTS: Quadriceps strength, knee laxity and alignment, and osteoarthritis progression. RESULTS: The predicted probability of tibiofemoral progression was 0.153 (95% CI, 0.100 to 0.228) in high-strength knees and 0.098 (CI, 0.061 to 0.155) in low-strength knees. In malaligned knees, high strength was associated with a significant increase (P = 0.03) in the likelihood of progression (predicted probability, 0.406 [CI, 0.226 to 0.615] vs. 0.187 [CI, 0.081 to 0.375] in high-strength vs. low-strength knees). Strength was also associated with increased likelihood of progression in high-laxity knees (P = 0.003 when high laxity was defined as > or =6.75 degrees). The probability of patellofemoral progression did not differ between high- and low-strength knees in the full sample or within subsets. CONCLUSIONS: Greater quadriceps strength at baseline was associated with increased likelihood of tibiofemoral osteoarthritis progression in malaligned knees and lax knees. Subset-specific approaches beyond strengthening exercises should be developed to enhance joint-protective muscle activity.
Body Mass Index↗
Statin use and leg functioning in patients with and without lower-extremity peripheral arterial disease.
BACKGROUND: We determined whether statin use (versus nonuse) is associated with superior lower-extremity functioning independently of cholesterol levels and other confounders in patients with and without peripheral arterial disease. METHODS AND RESULTS: Participants included 392 men and women with an ankle brachial index (ABI) <0.90 and 249 with ABI 0.90 to 1.50. Functional outcomes included 6-minute walk distance and 4-meter walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for 5 repeated chair rises into an ordinal score ranging from 0 to 12 (12=best). Adjusting for age, sex, ABI, comorbidities, education level, medical insurance status, cholesterol, and other confounders, participants taking statins had better 6-minute walk performance (1276 versus 1218 feet, P=0.045), faster walking velocity (0.93 versus 0.89 m/s, P=0.006), and a higher summary performance score (10.2 versus 9.4, P<0.001) than participants not taking statins. Positive associations were attenuated slightly after additional adjustment for C-reactive protein level but remained statistically significant for walking velocity and the summary performance score. We did not find significant associations between lower-extremity functioning and aspirin, ACE inhibitors, vasodilators, or beta-blockers. CONCLUSIONS: Statin use is associated with superior leg functioning compared with no statin use, independent of cholesterol levels and other potential confounders. These data suggest that non-cholesterol-lowering properties of statins may favorably influence functioning in persons with and without peripheral arterial disease.
Adrenergic beta-Antagonists↗
Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors.
OBJECTIVE: To identify factors that predict a poor physical function outcome over 3 years in individuals with knee osteoarthritis (OA), in an effort to aid in the development of strategies to prevent such functional limitations and consequential disability. METHODS: Community-recruited individuals with knee OA underwent baseline, 18-month, and 3-year assessments of candidate risk factors and physical function. Risk factors were age, body mass index (BMI), knee pain intensity (on a visual analog scale [VAS]), local mechanical and neuromuscular factors (varus-valgus laxity, malalignment, proprioceptive inaccuracy, quadriceps strength, hamstring strength), activity level (Physical Activity Scale for the Elderly, amount of aerobic exercise), and psychosocial factors (Short-Form 36 [SF-36] mental health and role-functioning emotional subscales, self-efficacy using the Arthritis Self-Efficacy Scale physical function subscale, and social support using the Medical Outcomes Study Social Support Survey). Outcome was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scale and rate of chair-stand performance. Participants were grouped by quintile of baseline WOMAC score. The baseline to 3-year outcome was considered "good" when function improved by 1 or more quintiles or remained within the 2 highest function groups, and was considered "poor" when function declined by 1 or more quintiles or remained within the 3 lowest function groups. The same approach was taken for chair-stand outcome. Logistic regression was used to evaluate both the baseline level and the baseline to 18-month change in each factor as a predictor of physical function outcome over 3 years, adjusting for age, BMI, knee pain intensity, disease severity, and additional potential confounders. RESULTS: Factors that significantly increased the likelihood of a poor WOMAC outcome were baseline laxity (crude odds ratio [OR] 1.48/3 degrees, 95% confidence interval [95% CI] 1.02-2.14), BMI (OR 1.26/5 units, 95% CI 1.01-1.57), knee pain intensity (OR 1.21/20 mm on VAS, 95% CI 1.00-1.47), and baseline to 18-month increase in knee pain (OR 1.32/20 mm on VAS, 95% CI 1.06-1.65). Factors that significantly protected against a poor WOMAC outcome were better baseline mental health (OR 0.62/5 points, 95% CI 0.44-0.87), self-efficacy (OR 0.79/5 points, 95% CI 0.67-0.93), and social support (OR 0.86/10 points, 95% CI 0.75-0.98), and greater amount of aerobic exercise (OR 0.75/60 minutes each week, 95% CI 0.63-0.89). Factors that increased the likelihood for a poor function outcome by the chair-stand performance rate were age and proprioceptive inaccuracy, and factors that reduced the likelihood for poor chair-stand outcome were strength (attenuated after adjusting for pain intensity or self-efficacy), self-efficacy, and aerobic exercise. Individuals who sustained high function and those who sustained low function over the 3 years were described. CONCLUSION: Factors placing individuals with knee OA at greater risk of a poor function outcome by at least 1 of the 2 function measures included the local factors laxity and proprioceptive inaccuracy, as well as age, BMI, and knee pain intensity. Factors protecting against a poor function outcome included strength, the psychosocial factors mental health, self-efficacy, and social support, and the activity level measured by the amount of aerobic exercise per week. The identification of these factors provides possible targets for rehabilitative and self-management strategies to prevent disability.
Aged↗
Depressive symptoms and lower extremity functioning in men and women with peripheral arterial disease.
OBJECTIVE: Factors associated with impaired functioning in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. The purpose of this study was to determine the relationship between depressive symptoms and objective measures of lower extremity functioning in persons with PAD. DESIGN: Cross-sectional. PATIENTS/PARTICIPANTS: Four hundred twenty-three men and women with PAD identified from 3 Chicago area medical centers. MEASUREMENTS AND MAIN RESULTS: PAD was defined as ankle brachial index (ABI) <0.90. The Geriatric Depression Scale short form (GDS-S) (0-15 scale, 15 = worst) was completed by all participants. A clinically significant number of depressive symptoms was defined as a GDS-S score >or=6. Six-minute walk distance and usual-and fast-pace walking velocity were determined for all participants. A GDS-S score >or=6 was present in 21.7% of participants with PAD. Adjusting for age, increasing numbers of depressive symptoms were associated with an increasing prevalence of leg pain on exertion and rest (P =.004). Adjusting for age, sex, race, ABI, number of comorbidities, current smoking, and antidepressant medications, increasing numbers of depressive symptoms were associated with shorter 6-minute walk distance (P <.001), slower usual-pace walking velocity (P =.005), and slower fast-pace walking velocity (P =.005). These relationships were attenuated slightly after additional adjustment for presence versus absence of leg pain on exertion and rest and severity of exertional leg symptoms. CONCLUSIONS: Among men and women with PAD, the prevalence of a clinically significant number of depressive symptoms is high. Greater numbers of depressive symptoms are associated with greater impairment in lower extremity functioning. Further study is needed to determine whether identifying and treating depressive symptoms in PAD is associated with improved lower extremity functioning.
Aged↗
The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease.
OBJECTIVE: Varus and valgus malalignment increase the risk of medial and lateral osteoarthritis (OA) progression, respectively. The impact of a mechanical factor such as alignment depends not only on the factor itself, but also on the state of the joint. The less-damaged joint of mild OA may be less vulnerable to malalignment effects than the more-damaged joint of moderate OA. Our goal was to explore the impact of alignment on subsequent progression of knee OA according to the baseline stage of disease. METHODS: Two hundred thirty patients with knee OA (defined by the presence of osteophytes and symptoms) recruited from the community underwent assessment of both lower limbs at baseline and at an 18-month followup. Alignment was measured on a full-limb radiograph as the angle made by the intersection of the femoral and tibial mechanical axes. Compartment-specific progression was defined as an increase between baseline and 18 months in the grade of severity of joint space narrowing on radiographs of semiflexed knees taken after fluoroscopic confirmation of position. Knees were grouped according to their baseline stage of OA as Kellgren/Lawrence (K/L) grades 0-1, 2, or 3. Progression odds ratios were estimated from logistic regression using generalized estimating equations. RESULTS: There were 377 K/L grade 0-3 knees in 230 subjects (173 women and 57 men, mean age 64.0 years, mean body mass index 30.4 kg/m(2)) in this longitudinal study. In knees with mild OA (K/L grade 2), the odds of 18-month progression in the medial compartment were significantly increased 4-fold by varus alignment at baseline. In K/L grade 2 knees, the odds of lateral progression were increased 2-fold by valgus alignment (approaching significance). In knees with moderate OA (K/L grade 3), the risk of progression was comparably increased by varus or valgus alignment (10-fold). CONCLUSION: While some effect of malalignment was suggested at almost all stages of knee OA examined, the impact of varus or valgus malalignment on the odds of OA progression over the ensuing 18 months was greater in knees with moderate (K/L grade 3) OA at baseline, possibly due to greater joint vulnerability with some contribution from slightly more severe malalignment.
Aged↗
Lower extremity performance is associated with daily life physical activity in individuals with and without peripheral arterial disease.
OBJECTIVES: To determine whether persons with poorer lower extremity functioning have reduced physical activity levels. DESIGN: Cross-sectional. SETTING: Three Chicago-area medical centers. PARTICIPANTS: Two hundred twenty-five people with lower extremity peripheral arterial disease (PAD) and 121 individuals without PAD. MEASUREMENTS: The summary performance score (SPS) was determined for all participants. The SPS combines data on walking velocity, time for five repeated chair rises, and standing balance. Each test is scored on a 0 to 4 scale (4 = best). Scores are summed to create the SPS (0-12 scale, 12 = best). All participants wore a vertical accelerometer for 7 days to measure physical activity. RESULTS: The SPS was associated linearly with 7-day physical activity levels of participants with (P< .0001) and without PAD (P< .0001). This relationship was maintained even after restricting analyses to subsets of participants who reported that they could walk a quarter of a mile and up and down stairs without difficulty (P< .001) and were able to walk for 6-minutes without stopping (P< .001). In multiple linear regression analyses, the SPS was associated with physical activity in participants with (P< .01) and without PAD (P< .001), adjusting for age, sex, race, comorbidities, ankle brachial index, neuropathy, and leg symptoms. CONCLUSION: In people with and without PAD who have impaired lower extremity performance, reduced physical activity levels may contribute to subsequent disability. Future study is needed to determine whether interventions to increase physical activity can prevent functional decline in persons with a low SPS.
Activities of Daily Living↗
Nonpharmacologic management of osteoarthritis.
Several nonpharmacologic interventions for osteoarthritis are in different stages of development, investigation, and application. Such interventions capitalize on current knowledge of the causes of symptoms, disease progression, and disability in patients with osteoarthritis. Many nonpharmacologic interventions are low in cost and incorporate self-management approaches or home-based activities and, as such, may ultimately have substantial public health impact. Recent studies and reviews of exercise, weight loss, education, inserts, footwear, bracing, therapeutic ultrasound, acupuncture, and pulsed electromagnetic field therapy will be highlighted in this review. For many of these interventions, further investigation will be necessary to define their place in the management of osteoarthritis.
Acupuncture Analgesia↗