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In Knee OA, Keep on Walkin'

Each additional 1,000 steps per day was associated with a 16% lower risk for later functional deterioration.

By Nancy Walsh, MedPage Today

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Individuals whose walking totaled 5,000 and 7,499 steps each day cut their osteoarthritis risk by half.
Individuals whose walking totaled 5,000 and 7,499 steps each day cut their osteoarthritis risk by half.
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Patients with knee osteoarthritis (OA) can decrease their likelihood of developing functional limitations , a study of older adults suggested.

Each additional 1,000 steps per day was associated with a 16% lower risk for later functional deterioration when assessed on an objective performance-based measure, and with an 18% decrease in risk on a self-report measure, according to Daniel K. White, ScD, PT, of Boston University, and colleagues.

And individuals whose walking totaled 5,000 and 7,499 steps each day cut their risk by half, with adjusted relative risks of 0.50 on the performance measure and 0.51 on the self-report measure, the researchers reported online inArthritis Care &Research.

TheOAResearchSocietyInternationalrecommendsexerciseasasuitablenonpharmacologictreatmentforpatientswithOA; however, a recent survey of U.S. primary care physicians found that fewer than one-third advise their OA patients to exercise.

But exercise is only one form of physical activity, according to White and colleagues, in that it's typically "planned, structured, and recurring," whereas physical activity can include energy output in ordinary, unstructured activities -- such as walking.

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"While there is support that strength training and aerobic exercise improve physical function in knee OA, it is not known whether there are added benefits from unstructured physical activity," the researchers wrote.

To examine the effects of walking on future functional disability, White's group analyzed data from a subset of patients in the Multicenter Osteoarthritis (MOST) study who had been given an accelerometer-based activity monitor to wear for 7 consecutive days.

The performance-based measure was defined as a gait speed below 1 meter per second, and the self-reported measure was a score of 28 or higher on the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) physical function subscale.

The analysis included 1,788 individuals whose mean age was 67 and whose mean body mass index was 30.7 kg/m2.

A total of 60% were women. Mean physical function score on the WOMAC was 11.8 at baseline, and mean knee pain rating on a 100-point visual analog scale was 18.8. Baseline gait speed averaged 1.22 meters per second.

At 2-year follow-up, 8% and 4% of those with no functional limitations at baseline were determined to have limitations according to performance and self-report measures, respectively.

Individuals whose daily steps exceeded 7,500 fared even better than those in the 5,000 to 7,499 step group, with adjusted relative risks for incident functional impairment of 0.31 on the performance measure and 0.41 on the self-report WOMAC measure.

The researchers also compared the rates of incident functional impairment among patients with radiographic OA and those with symptomatic OA, and found that in the radiographic group, 10% and 6% were impaired by 2 years according to performance and self-report measures, as were 13% and 10% in the symptomatic group.

The physical activity cutpoints with the greatest balance between sensitivity and specificity were 6,000 steps per day according to the performance measure, and 5,900 on the self-report measure.

An initial goal of 3,000 steps per day might be a suitable minimum at the outset, because few individuals with that level of physical activity were functioning poorly at 2 years, according to the researchers.

That could then be increased to 6,000 steps per day, which may be a more realistic goal than the popular 10,000 per day for the general population, they noted.

"Rather than promoting potentially difficult-to-achieve walking activity goals that could further discourage people with knee OA, our study results suggest that lower targets may still provide therapeutic benefits," they wrote.

"These steps-per-day thresholds merit further evaluation as improving daily walking may be an inexpensive means of minimizing functional limitations in knee OA," they concluded.

Limitations of the study included potential differences in monitoring and estimating steps per day, and the likelihood of physical functioning fluctuating over time.






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Date: 16.12.2018, 02:55 / Views: 71275