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Strenuous exercise safe for people at high risk of knee arthritis

People at high risk for knee osteoarthritis (OA) may be nervous and reluctant to participate in strenuous physical activities such as jogging, cycling, singles tennis and skiing. But a new study showed vigorous exercise did not increase their risk of developing OA and may even protect them from it.

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People at high risk for knee osteoarthritis (OA) may be nervous and reluctant to participate in strenuous physical activities such as jogging, cycling, singles tennis and skiing. But a new Northwestern Medicine study that followed high-risk individuals for 10 years showed vigorous exercise did not increase their risk of developing OA and may even protect them from it.

“Our study findings convey a reassuring message that adults at high risk for knee OA may safely engage in long-term strenuous physical activity at a moderate level to improve their general health and well-being,” said Alison Chang, associate professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine.

The study is published in JAMA Network Open.

Osteoarthritis is the most common joint disorder in the United States, affecting an estimated 32.5 million adults, according to the Centers for Disease Control. The knee is the most commonly affected joint. The lifetime risk of developing symptomatic, radiographic knee OA (as diagnosed on an x-ray) is approximately 38% to 45%. The estimated median age of diagnosis is 55 years.

In this observational study of 1,194 persons at high risk for but without radiographic evidence of knee OA who were followed for up to 10 years, long-term participation in strenuous physical activities was not associated with risk of developing radiographic knee OA. In fact, the vigorously exercising individuals in the study were 30% less likely to develop OA, although the number was not considered statistically significant.

The activities included jogging, swimming, cycling, singles tennis, aerobic dance and skiing. Persistent extensive sitting was not associated with either elevated or reduced risk.

Excessive body weight, history of joint injury or surgery, aging and chronic knee symptoms place an individual at elevated risk for developing knee OA. Although regular physical activity and exercise provide multiple health benefits, uncertainty about whether vigorous physical activity participation could cause pain and further tissue damage is a common concern. The researchers’ analysis showed nearly 50% of the adults at high risk for this disease did not engage in any strenuous physical activity over eight years.

“People suffering from knee injuries or who had arthroscopic surgical repair of ACL or meniscus are often warned that they are well on the path to develop knee OA,” Chang said. “They may be concerned that participating in vigorous activities or exercises could cause pain and further tissue damage. To mitigate this perceived risk, some have cut down or discontinue strenuous physical activities, although these activities are beneficial to physical and mental health.”

The study analyzed data from the Osteoarthritis Initiative, a longitudinal observational study of men and women (age range: 45 to 79 years) with or at an increased risk of developing knee OA, recruited from four communities in the U.S. At the study onset and subsequent visits for up to 10 years of follow-up, the participants received X-rays for both knees to determine knee OA disease status and reported their weekly strenuous physical activity participation and sitting patterns.

In 1,194 participants who had no knee OA confirmed by X-ray at the study onset, researchers identified four distinct long-term trajectory patterns of strenuous physical activity participation and three distinct trajectory patterns of extensive sitting over an 8-year period. They then examined if long-term engagement of strenuous physical activity or extensive sitting behavior were each associated with risk of developing knee OA.

“Adults at high risk for knee OA may safely engage in long-term strenuous physical activity at a moderate level,” Chang said. “Health care providers may consider incorporating physical activity counselling as part of the standard care for high-risk individuals at an early stage when physical activity engagement is more attainable.”

Other Northwestern authors include Dr. Leena Sharma, Julia Lee, Joan Chmiel, Orit Almagor and Jing Song.

Fitness

Treatment options to help overcome knee pain for sports enthusiasts

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

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Millions of people experience chronic pain, with knee pain among the most common. Athletes and active adults know the impact activities like running and skiing can have on their knees, but when chronic knee pain makes it difficult to do those activities, or even day-to-day tasks like walking up the stairs, people may often face challenges.

According to the journal “Cartilage,” unlike other tissues, cartilage does not repair itself and, without proper treatment, can worsen over time and become more difficult to treat. However, options like FDA-approved knee cartilage repair surgery MACI (autologous cultured chondrocytes on porcine collagen membrane) uses a patient’s cells to help repair cartilage defects and may help alleviate knee pain.

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

Justin Keys, a former patient of Meininger and avid skier, knows that the long-term outcomes of knee cartilage surgery can be worth the short-term sacrifices. After several injuries, including an ACL injury, Keys struggled with most activities except walking on flat, paved surfaces. After consulting with Meininger, Keys chose knee cartilage repair to help get back to his active lifestyle.

Keys considered whether to manage the injury as-is or choose MACI and undergo rehabilitation to potentially get back to his favorite activities in the future. He knew he could no longer use short-term relief methods and had to address his pain with a treatment to help provide lasting relief.

For athletes like Keys who want to fix knee pain, it’s important to consider these steps:

Discuss Options with Your Doctor

Patients should talk to their doctors and undergo an MRI to help assess the internal structures of the knee. Meininger recommends patients and their doctors discuss options for long-term knee restoration health, preserving function for future decades and recognizing the short-term sacrifice.

Set Yourself Up for Success

Experts like Meininger suggest patients take steps ahead of surgery to help their recovery.

“The important thing is to be as fit as possible and use the preseason months to undergo surgery and rehab,” Meininger said.

Patients can take steps to prep their home for recovery, which may include:

  • Bringing necessities down from hard-to-reach shelves
  • Moving furniture to ensure clear pathways
  • Installing shower safety handles to minimize potential falls

The Road to Rehab and Recovery

Rehabilitation takes time and everyone’s experience is unique. It can be as much of a mental challenge as it is physical. Committing to a physical therapy regime, staying hydrated and eating well are important aspects to support recovery. Patients should talk to their doctors with questions and before starting any exercises.

IMPORTANT SAFETY INFORMATION

Do not use if you are allergic to antibiotics such as gentamicin or materials from cow or pig; have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue or blood clotting conditions; had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant; or cannot follow a rehabilitation program post-surgery.

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Fitness

6 Exercise safety tips

Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

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In the wake of the COVID-19 pandemic, many Americans are more aware of their health and wellness. Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

Sprains, strains and injuries can happen to even the most seasoned athletes. When you’re testing your limits, even a minor injury can alter your performance. Consider products and supports like these from the CURAD Performance Series product line, available at Walmart and Amazon, to help you get back in the game quickly and safely.

Find more resources to support your fitness journey at CURAD.com.

Keep Dirt and Germs Away

The more active you are, the harder it can be to find a bandage that stays with you all day or all game long.

Spray Away Sore Spots

Controlling mild pain can help keep you at the top of your game, and a topical analgesic works fast to heal common pain brought on by fitness and exercise, such as pain in knees, feet, shoulders and backs.

Put Pain in the Past

When recovery becomes the name of the game and pain relief is needed after daily workouts or bodily injuries. Cold packs work to heal bruises, reduce swelling and relieve headaches and general pain points while microwavable heat packs provide satisfying heat therapy to address sore and stiff joints, muscle cramps and tension.

Reduce Impact of Knee Strain

Weak, injured or arthritic knees can come from many sources, including tendonitis and a wide range of conditions that result in strain or overuse. An adjustable band can provide support for on-field sports and during workouts or everyday activities.

Manage Pain and Relieve Pressure

If you participate in endurance and strength exercises or certain sports, you may ask a lot of your joints. Kinesiology tape can be configured a multitude of ways to help reduce pain and improve blood circulation, as well as relieve tension and pressure.

Control Back Strain

When your back is strained, your body and performance can suffer. A mild or moderate sprain can benefit from strong support and compression.

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Fitness

Exercise can provide relief for dry, itchy eyes

A significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.

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Photo by Quinten de Graaf from Unsplash.com

A team led by researchers from the University of Waterloo discovered that a significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes. 

Every time we blink, our eyes are covered in tear film—an essential protective coating necessary for maintaining healthy ocular function. Healthy tear film comprises three layers–oil, water, and mucin–that work together to hydrate the ocular surface and protect against infection-causing irritants like dust or dirt.

When any part of the tear film becomes unstable, the ocular surface can develop dry spots, causing eye symptoms like itchiness or stinging and burning sensations.

“With so much of our activity tied to screen usage, dry eye symptoms are becoming increasingly common,” said Heinz Otchere, a PhD candidate in vision science at Waterloo. “Instead of having to use eye drops or other alternative treatments, our study aimed to determine if remaining physically active can be an effective preventative measure against dryness.”

Fifty-two participants were divided into two groups—athlete and non-athlete—to participate in an exercise session. Participants in the athlete group exercised at least five times per week, while non-athlete participants exercised no more than once per week. Researchers, which included experts from the University of Cape Coast in Ghana, performed visual examinations before and five minutes after each exercise session, where tear secretion and tear break-up time were assessed.

While participants in the athlete group showed the largest increase, Otchere says all participants experienced a meaningful boost in tear quantity and tear film stability after the exercise session. 

“It can be challenging for people to regularly exercise when the demand is there to work increasingly longer hours in front of screens,” Otchere said. “However, our findings show physical activity can be really important for not just our overall well-being, but for our ocular health too.”

The study, Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes, was co-authored by Otchere, the University of Cape Coast’s Samuel Abokyi, Sekyere Nyamaah, and Michael Ntodie, and Ghana’s Our Lady of Grace Hospital’s Yaw Osei Akoto. It was recently published in the Experimental Eye Research journal.

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