Physical Exercise and Weight Loss for Hip and Knee Osteoarthritis in Very Old Patients: A Systematic Review of the Literature
Jean-Laurent Le Quintrec 1, Bernard Verlhac 2, Christian Cadet 3, Philippe Bréville 4, Jean M Vetel 5, Jean B Gauvain 6, Claude Jeandel 7, Emmanuel Maheu*, 8
Identifiers and Pagination:Year: 2014
First Page: 89
Last Page: 95
Publisher ID: TORJ-8-89
Article History:Received Date: 10/6/2014
Revision Received Date: 16/10/2014
Acceptance Date: 16/10/2014
Electronic publication date: 28 /11/2014
Collection year: 2014
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.
Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles.
We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients.
Physical exercise (8 trials):
was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation.
Aquatic exercise (5 trials):
was as effective as land-based exercise.
Weight loss (2 trials):
only patients under diet + exercise had significant improvement on symptoms.
Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.