Osteorthritis and your Elder Parents

Arthritis is a disabling problem for our elderly parents. Arthritis leads to name a few: an increase in frailty, decreased mobility leading to loss of muscle mass, increased obesity, decreased quality of life, and an increase in the chance of falls. Importantly, all these factors combine to increase their risk of entering a nursing home as well.

Arthritis can increase your parents risk of fall by almost 2.5 times, especially if they already have other health problems such as heart or lung disease. People with arthritis struggle with decreased strength because of increased pain in their joints, and consequential muscle atrophy. They have decreased ability to detect where their limbs are in space called “proprioception” making safe movements a problem. Of course, pain is a major issue, limiting movements, and correction of unwanted movements and reduced range of motion. These combine to reduce balance, leading to falls, a life-threatening rsk.

So what can be done about arthritis? Arthritis is a huge topic, and people make careers out of arthritis treatment, such as rhematologists. So everything I will say hereon will only offer some simple tips. Still, I think they can be handy.

Many studies on older adults include stretching exercises as part of a well-rounded exercise program. For example, the Arthritis Foundation supports that stretching particularly benefits those with arthritis by lubricating joints and enhancing and maintaining range-of-motion. In fact, for general fitness, the American College of Sports Medicine recommends static stretching for most individuals, preceded by an active warm-up, at least 2 to 3 days per week. Each stretch should be held 15-30 seconds and repeated 2 to 4 times.

Older adults may need longer stretch times. Feland et al⁸⁵ found that 60-second holds of static stretches were associated with greater improvements in hamstring flexibility in older adults (compared to shorter durations).

How long does it take to become more “flexible”? In one study, ten weeks of stretching of the trunk muscles was able to increase spinal mobility in older adults.

Static Stretching

In addition, static stretching (holding the stretch without moving) of the hip flexors and extensors may also improve gait in older adults. However, men and older adults under 65 years may respond better to contract-relax (see below) stretching, while women and older adults over 65 may benefit more from static stretching.

A complicated type of static stretching called “Contract-Relax stretching or PNF stretching” involves a maximal or sub maximal contraction of the muscle that you are stretching for about 5-10 seconds followed by a passive stretch for 20-25 seconds.

For example, if you were to stretch your hamstrings muscles while seated, you could place your leg (with your knee straight) on a chair in front of you and lean forward until you felt a slight stretch. Then, you would “contract” the hamstring muscles followed by gently pushing down in to the chair for 5-10 seconds.

This is followed by a few seconds of relaxing the stretch. You then repeat 3-4 more times. Note there is no major dynamic joint movement. There may be evidence that this kind of stretching is better to improve the joints, but I’d stay stick with the one you like best.

What we do know is that static stretching is effective at increasing range of motion, (therefore decreasing the risk of falls). The greatest change in ROM with a static stretch occurs between 15 and 30 seconds and repeated 3-4 times. In the literature, static stretching is effective in making longer lasting changes in muscle length,. Also, static stretching may be more effective after an exercise session to help reduce muscle soreness.

Dynamic Stretching

Does “dynamic stretching” work even better? Dynamic stretching basically is stretching out those same muscles you want in static stretching but without holding them, and without approaching their range of motion limit, and of course, as the name implies, moving them. Some examples: torso twists, arm circles, knee-high jogging, lunge walks and standing leg circles.

However, several studies indicate no difference in performance when comparing static and dynamic stretching. Again, I’d go with the one that you like best that day. Sometimes you’d probably want to vary, especially if you feel very stiff in the morning. A good static stretch simply feels good sometimes.

Check out some examples of dynamic stretching for “joint mobility exercises”,

https://www.healthline.com/health/fitness-exercise/joint-mobility-exercises#3

For athletes in particular, it could be argued that dynamic stretching is the most effective way to warm up before an activity. It allows the muscle to warm up at the same time. However, dynamic stretching alone has not been shown to consistently make long term changes in the length of a tight muscle.

Exercise and Sports in the Prevention of OA

Exercise has been shown to improve pain and function in osteo-arthritis and is recommended by the Osteoarthritis Research Society International.

However, to date, very little research has been conducted to investigate whether exercise and sports can also be used to prevent the onset of OA.

It is widely recognized that physical activity is beneficial for cardiovascular health, facilitates weight loss and prevents weight gain. As obesity is a recognized risk factor for knee OA (osteo-arthritis), exercise is thought to help combat OA disease progression.

Animal and human studies have shown protective effect of exercise and of muscle strength in the prevention of cartilage loss, a major factor in osteoarthritis. In one study, participants with the greatest quadriceps strength displayed the least cartilage loss in the knee joint indicating that a strong quadriceps muscle had protective cartilage effects.

Another study, involved participants who had undergone partial medial meniscectomies (a type of knee operation) beforehand. Some of them completed a 4-month exercise program, while the rest remained at their current physical exercise level. At the end of the study, 68% of the exercise group reported an increase in activity level. Furthermore, glycosaminoglycan levels (an indication of cartilage health) which were measured by MRI scans were significantly increased, indicating that persistent exercise also has a beneficial direct effect on our cartilage structure. Another lesson learned: inactivity promotes muscle weakness and joint instability and can lead to cartilage damage directly.

Other studies indicate that IL-10, an anti-inflammatory “cytokine” (a type of cell protein used to tell our cells what to do), is increased after resistance exercise in OA patients. This translates into less pain, and results in the ability to exercise more frequently, leading to increased muscle mass, and finally provide more joint stability.

Risk factors for Osteo-arthritis

• Older age.
• Being a woman means you are more likely to develop osteoarthritis,
• Obesity. More weight translates into more weight on the joints, as well as more inflammation.
• Previous Joint injuries. Sports or car accidents for example increase the risk of future OA. Activities requiring extreme and improper joint movements such as squatting (especially with weights) or even prolonged standing have also been linked to a higher risks
• Genetics. A family history of osteoarthritis increases your risk
• Bone deformities. malformed joints or defective cartilage can increase the risk of osteoarthritis.
• Race: African Americans demonstrate more knee and hip symptoms than Whites
• Jobs: repetitive stress on a particular joint in some jobs more than others may eventually lead to osteoarthritis.

Local Risk Factors

Obesity
Obesity and overweight are recognized as major risk factors for OA, especially OA of the knees. Overloading the knee and hip joints could lead to synovial joint breakdown and failure of ligamentous and other structural support.

The “Framingham Study” demonstrated that women who had lost about 5 kg had a 50% reduction of knee OA. The same study also found that weight loss was a big factor in reducing the risk of knee OA. Weight-loss has also been shown to decrease pain and disability in established knee OA.

This modest 5 kg loss is reminiscent of a study demonstrating that modest weight losses of 5 to 10% lead to significant improvements in CVD risk factors after 1 year, (but larger weight losses had greater benefits.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120182/

The Arthritis, Diet, and Activity Promotion Trial showed that weight loss combined with exercise were decreased pain and improved function in obese elders who had symptomatic knee OA.

A meta-analysis (from the combined results of several studies) concluded that weight reduction by about a 5% was associated with an improvement of physical function.

Hips: there is evidence that obesity increases the risk of bilateral radiographic (seen from x-rays) as well as symptomatic hip OA.

In the Nurses’ Health Study, a higher BMI (especially starting at age 18) was strongly associated with an increased risk of total hip replacement therapy.

Injury/surgery
Numerous studies show that knee injury is one of the strongest risk factors for OA.

Severe injury to the joint can result in an increased risk of OA development and musculoskeletal symptomatology.In the Framingham Study the prevalence of knee joint damage was much higher among subjects with radiographic knee OA (82%) than those without OA (25%).

Take home message:

1) Avoid overstressing the joints and joint injury
2) Practice stretching and exercise daily
3) Avoid overweight and obesity