Estimation of ??VO2 in older individuals with osteoarthritis of the knee and cardiovascular disease

Berry, Michael J.; Brubaker, P H; O’Toole, Mary L.; Wj, Rejeski; Soberman, Judith E.; Ribisl, Paul M.; Miller, H S; Afable, Richard; Applegate, William B.; Ettinger, Walter H.

doi:10.1097/00005768-199607000-00006

Cited by 29 publications

(15 citation statements)

References 18 publications

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“…Potential participants were excluded if they met any of the following criteria: 1) serious medical condition that prevented safe participation in an exercise program, including symptomatic heart or vascular disease (angina, peripheral vascular disease, congestive heart failure), severe hypertension, recent stroke, chronic obstructive pulmonary disease, severe insulin‐dependent diabetes mellitus, psychiatric disease, renal disease, liver disease, active cancer other than skin cancer, and anemia; 2) a Mini‐Mental State Examination score of <24; 3) inability to finish the 18‐month study or unlikely to be compliant; 4) inability to walk without a cane or other assistive device; 5) participation in another research study; 6) reported alcohol consumption of >14 drinks per week; 7) ST segment depression of at least 2 mm at an exercise level of 4 METS or less, hypotension, or complex arrhythmias during a graded exercise test (36); 8) inability to complete the protocol, in the opinion of the clinical staff, because of frailty, illness, or other reasons.…”

Section: Methodsmentioning

confidence: 99%

Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial

Messier

Loeser

Miller

et al. 2004

Arthritis & Rheumatism

Self Cite

951

828

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Objective. The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was a randomized, single-blind clinical trial lasting 18 months that was designed to determine whether long-term exercise and dietary weight loss are more effective, either separately or in combination, than usual care in improving physical function, pain, and mobility in older overweight and obese adults with knee osteoarthritis (OA).Methods. Three hundred sixteen communitydwelling overweight and obese adults ages 60 years and older, with a body mass index of >28 kg/m 2 , knee pain, radiographic evidence of knee OA, and self-reported physical disability, were randomized into healthy lifestyle (control), diet only, exercise only, and diet plus exercise groups. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included weight loss, 6-minute walk distance, stair-climb time, WOMAC pain and stiffness scores, and joint space width.Results. Of the 316 randomized participants, 252 (80%) completed the study. Adherence was as follows: for healthy lifestyle, 73%; for diet only, 72%; for exercise only, 60%; and for diet plus exercise, 64%. In the diet plus exercise group, significant improvements in selfreported physical function (P < 0.05), 6-minute walk distance (P < 0.05), stair-climb time (P < 0.05), and knee pain (P < 0.05) relative to the healthy lifestyle group were observed. In the exercise group, a significant improvement in the 6-minute walk distance (P < 0.05) was observed. The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures. The weight-loss groups lost significantly (P < 0.05) more body weight (for diet, 4.9%; for diet plus exercise, 5.7%) than did the healthy lifestyle group (1.2%). Finally, changes in joint space width were not different between the groups.Conclusion. The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone.Arthritis is the leading cause of physical disability among older adults, affecting more than 70 million Americans, of whom the majority are women (1-4). The joint damage and chronic pain from osteoarthritis (OA), the most common form of arthritis, lead to muscle atrophy, decreased mobility, poor balance, and, eventually, physical disability (5-8). Traditional therapies include pharmacologic, surgical, and exercise interventions. Pharmacologic therapy includes the use of antiinflammatory medications that have potentially serious long-term side effects (9,10). Recent evidence also casts doubt as to the effectiveness of arthroscopic surgery for adults with mild to moderate knee OA (11).

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Section: Methodsmentioning

confidence: 99%

Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial

Messier

Loeser

Miller

et al. 2004

Arthritis & Rheumatism

Self Cite

951

828

View full text Add to dashboard Cite

show abstract

“…Briefly, inclusion criteria included: (1) age ≥ 60 years; (2) overweight or obese (BMI ≥ 28.0 kg*m −2 ); (3) radiographic evidence in one or both knees of Kellgren-Lawrence grade I-III tibiofemoral OA in weight-bearing anteroposterior view and/or patellofemoral OA in sunrise view; (4) no more than 20 minutes of regular exercise per week; (5) self-report of knee pain on most days of the month; (6) self-report of difficulty due to knee pain in one or more daily activities (e.g., walking one-quarter mile, shopping, bending, etc); and (7) willingness to undergo testing and intervention procedures. Exclusion criteria included: (1) serious co-morbid medical condition that could prevent safe participation in an exercise program; (2) score of < 24 on Mini-Mental State Exam (MMSE); (3) inability or unwillingness to modify dietary and/or exercise behaviors; (4) inability to complete the 18-month study or probability of noncompliance; (5) inability to walk without a cane or other assistive device; (6) participation in another interventional research study; (7) self-reported alcohol consumption of > 14 drinks per week; or (8) ST-segment depression of > 2 mm at an exercise level of 4 METs or less, hypotension or complex arrhythmias during a graded exercise test (16). …”

Section: Methodsmentioning

confidence: 99%

Does high weight loss in older adults with knee osteoarthritis affect bone-on-bone joint loads and muscle forces during walking?

Messier

Legault

Loeser

et al. 2011

Osteoarthritis and Cartilage

114

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Objective The aim of this study was to examine the effects of high weight loss on knee joint loads during walking in participants with knee OA. Design Data were obtained from a subset of participants enrolled in the Arthritis, Diet, and Activity Promotion Trial (ADAPT). Complete baseline and 18 month follow-up data were obtained on 76 sedentary, overweight or obese older adults with radiographic knee OA. Three-dimensional gait analysis was used to calculate knee joint forces and moments. The cohort was divided into high (> 5%), low (< 5%), and no (0% or gain) weight loss groups. Results From baseline body weight, the high weight loss group lost an average of 10.2%, the low weight loss group lost an average of 2.7%, and the no weight loss group gained 1.5%. Adjusted 18 month outcome data revealed lower maximum knee compressive forces with greater weight loss (p = 0.05). The difference in compressive forces between the high weight loss and no weight loss groups was due primarily to lower hamstring forces (p = 0.04). Quadriceps forces were similar between the groups at 18 month follow-up. There was no difference between the groups in 18-month joint space width or Kellgren-Lawrence scores. Conclusions These results suggest that a 10% weight loss in an overweight and obese osteoarthritic population elicits positive changes in the mechanical pathway to knee osteoarthritis by having lower knee joint compressive loads during walking compared to low and no weight loss groups. The difference in compressive forces was due, in large part, to reductions in hamstring co-contraction during the initial portion of the stance phase.

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“…All tests were conducted using a modified Naughton procedure (Berry et al, 1996). A Quinton 3000B EKG was used during the test to monitor heart function and a physician was present during the testing.…”

Section: Maximal Oxygen Consumption (Vo 2 Max ) Testmentioning

confidence: 99%

Gender Differences in Cardiovascular and Hypothalamic-Pituitary-Adrenal Axis Responses to Psychological Stress in Healthy Older Adult Men and Women

Traustadóttir

Bosch

Matt

2003

Stress

106

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Gender differences in the neuroendocrine and cardiovascular response to psychological stress may contribute to the gender differences in the prevalence of diseases associated with hypothalamic-pituitary-adrenal (HPA) axis reactivity such as cardiovascular disease (CVD), diabetes and hypertension. We measured plasma ACTH, cortisol, heart rate (HR), and blood pressure (BP) responses in 8 men and 8 women (55-75 years) exposed to the Matt Stress Reactivity Protocol (MSRP), a psychological challenge. The MSRP elicited significant increases in HR, systolic-, and diastolic BP, ACTH and cortisol (all p<0.01). Men had significantly greater cortisol and diastolic BP responses compared to women (p<0.05). Additionally, a positive correlation between the ACTH and cortisol responses was only found in the males (r=0.71, p<0.05). There were no group differences in HR, systolic BP, or ACTH responses. We conclude, that among older adults, men respond to psychological stress with greater increases in cortisol, compared to women. This greater activation of the HPA axis could translate into an elevated risk for CVD, diabetes and hypertension and may be related to the higher prevalence of these diseases in males. Gender differences in brain structures and/or cognitive processes may be responsible for these sexually dimorphic stress responses.

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Estimation of ??VO2 in older individuals with osteoarthritis of the knee and cardiovascular disease

Cited by 29 publications

References 18 publications

Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial

Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial

Does high weight loss in older adults with knee osteoarthritis affect bone-on-bone joint loads and muscle forces during walking?

Gender Differences in Cardiovascular and Hypothalamic-Pituitary-Adrenal Axis Responses to Psychological Stress in Healthy Older Adult Men and Women

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