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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

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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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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Fitness

Late-life exercise shows rejuvenating effects on cellular level

Late-life exercise mitigates skeletal muscle epigenetic aging.

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For people who hate exercising, here comes some more bad news: it may also keep you younger. Not just looking younger, but actually younger, on an epigenetic level. By now, the benefits of exercise have been well established, including increased strength of bones and muscles, improved mobility and endurance, and lower risk of heart disease, diabetes and high blood pressure.

But younger?

A study recently published in Aging Cell, “Late-life exercise mitigates skeletal muscle epigenetic aging,” suggests this could be the case. The paper was written by a team of seven researchers across three institutions, including Kevin Murach, an assistant professor in the Department of Health, Human Performance and Recreation at the U of A. Murach’s grant from the National Institute of Health funded the study, and he was one of three co-first authors.

Bootcamp for Mice

While the paper is dense with data, reflecting the use of several analytic tools, the experiment that generated the data was relatively straightforward. Lab mice nearing the end of their natural lifespan, at 22 months, were allowed access to a weighted exercise wheel. Generally, mice require no coercion to run and will do so voluntarily. Older mice will run anywhere from six to eight kilometers a day, mostly in spurts, while younger mice may run up to 10-12 kilometers. The weighted wheel ensured they built muscle. While there isn’t a direct analogue to most human exercise routines, Murach likened it to “a soldier carrying a heavy backpack many miles.”

When the mice were studied after two months of progressive weighted wheel running, it was determined that they were the epigenetic age of mice eight weeks younger than sedentary mice of the same age — 24 months. Murach noted that while the specific strain of mice and their housing conditions can impact lifespans, “historically, they start dropping off after 24 months at a significant rate.” Needless to say, when your lifespan is measured in months, an extra eight weeks — roughly 10 percent of that lifespan — is a noteworthy gain.

Methylation, My Dear Watson

The science behind this, while complicated, hinges largely on a biological process known as DNA methylation. A recent New York Times article discussing Murach’s work on muscle memory described methylation “as a process in which clusters of atoms, called methyl groups, attach themselves to the outside of genes like minuscule barnacles, making the genes more or less likely to turn on and produce particular proteins.”

As the body ages, there tends to be increased DNA methylation, or even hypermethylation, at promoter sites on genes in muscle. “DNA methylation changes in a lifespan tend to happen in a somewhat systematic fashion,” Murach explained, “to the point you can look at someone’s DNA from a given tissue sample and with a fair degree of accuracy predict their chronological age.” Due to this, researchers can use one of a number of “methylation clocks” to determine the age of a DNA sample.

DNA Methylation, Aging and Exercise

While the paper strengthens the case for exercise, there is still much that needs to be learned. Though the connection between methylation and aging is clear, the connection between methylation and muscle function is less clear. Murach is not yet prepared to say that the reversal of methylation with exercise is causative for improved muscle health. “That’s not what the study was set up to do,” he explained. However, he intends to pursue future studies to determine if “changes in methylation result in altered muscle function.”

“If so, what are the consequences of this?” he continued. “Do changes on these very specific methylation sites have an actual phenotype that emerges from that? Is it what’s causing aging or is it just associated with it? Is it just something that happens in concert with a variety of other things that are happening during the aging process? So that’s what we don’t know.”

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