The idea made so much sense that it was rarely questioned: exercise to strengthen the muscles around the knee helps patients with osteoarthritis, making the swollen joint easier to move and less painful. .
About 40 percent of Americans over the age of 65 have osteoarthritis of the knee, and millions of patients have been instructed to perform these exercises. In fact, the American College of Rheumatology and Arthritis Foundation regularly Recommend strength training to improve symptoms.
Stephen Messier, a professor of biomechanics at Wake Forest University, believed in the guidance. But they decided to put a prescription for the trial, involving 377 participants in 187 clinical trials. The verdict came out This week a study was published in JAMA: Strength training did not help with knee pain.
One group lifted heavy weights three times a week, while the other group attempted moderate strength training. A third group was consulted on “staying healthy” and instructed on foot care, nutrition, medication management, and better sleep practices.
Dr. Messier expected that the heavy lifting group would perform best and that participants who only received counseling would not experience any improvement in knee pain. But the results were similar in all three groups. All reported reduced pain, with only consultation received.
You can expect some relief in pain in exercising patients. But why would those who did not exercise also report an improvement? “This is an interesting dilemma that we have been put into,” Dr. Messier said.
A simple placebo effect could explain why they felt better, he said. Or it may be that some scientists call this effect regression: the symptoms of arthritis increase and decrease, and people seek treatment when the pain is at its peak. When it declines, as it would anyway, they describe improvements in treatment.
“The natural history of osteoarthritis of the knee includes waxing and reducing symptoms,” said Dr. Adolf Yates, vice chairman of orthopedic surgery at the University of Pittsburgh School of Medicine. “This is what makes it difficult to study osteoarthritis of knee intervention.”
Professor of Medicine at Boston University, Drs. David Felsen argued that the study did not find that strength training was useless. But instead, tests showed that very aggressive strength training was not helpful and could actually be harmful, he said, especially if the knees are bent inward or outward, as is common.
Strong muscles can act like a stretch, exerting pressure on small areas of the knee that bear most of the weight while we are walking. When dr. When Felsen investigated the study data, he indicated that the high-intensity group experienced slightly more pain and worse functioning.
Professor of Orthopedic Surgery at Weill Cornell Medical College in New York City, Drs. Robert Marx said, “They want a reason not to exercise:” Will it make my arthritis better? Will this improve my X-ray? “”
He tells them that their questions are not answered, but this exercise stabilizes the joints. Although it is not as effective against pain as anti-inflammatory drugs, “it is a piece of treatment for arthritis.”
Dr has been researching arthritis and exercise for over 30 years. For Messier, the new findings are a departure. His first study, Published in JAMA in 1997, found that the exercise groups had less pain at the end than the control group but did not actually because the participants were better. This occurred because the control group deteriorated.
They also observed that half of the participants in their study were overweight or obese. “What if we have lost weight to exercise?” He asked.
He tried that Another study, Which was published in JAMA in 2013, showed that the combination of weight loss and exercise reduced pain to a greater extent than alone.
But he had long wondered if the intensity of strength training mattered. In previous studies, participants used weights that fell far short of what they could actually lift; The trial lasted just six to 24 weeks, and patients showed only modest improvement in pain and functioning.
Despite the new, unexpected results, Drs. Messier still tells patients to exercise, this can prevent the inevitable decline in muscle strength and mobility. But it is now clear that there is no particular benefit of reinforcing training with heavy weights rather than moderate-intensity routines with more repetitions and lighter weights.
He said that arthritis is a chronic degenerative disease of the entire joint. “There’s a lot of stuff going on,” Dr. Messier said. “It’s not just cartilage erosion.”
But, he said, he believes the best non-drug intervention for knee pain is 10 percent weight loss and moderate exercise.
Dr. Messier is now planning that his next study will combine weight loss with exercise in people at risk for osteoarthritis of the knee in hopes of preventing the onset of this disabling disease.