Quintrec Jean-Laurent Le, Verlhac Bernard, Cadet Christian, Bréville Philippe, Vetel Jean M, Gauvain Jean B, Jeandel Claude, Maheu Emmanuel
Service de Médecine Gériatrique 3 [Department of Geriatric Medicine 3], Hôpital Sainte-Périne (A.P-H.P), Paris, France.
Pôle Vieillissement, réadaptation et Accompagnement [Centre for the Aged, Rehabilitation and Support], Hôpital Paul Brousse (A.P-H.P) Villejuif, France.
Open Rheumatol J. 2014 Nov 28;8:89-95. doi: 10.2174/1874312901408010089. eCollection 2014.
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.
风湿病学和老年医学学术组织对髋膝关节骨关节炎管理的建议强调非药物治疗的有效性，但未根据患者年龄和身体状况进行分级。我们对高龄患者髋膝关节骨关节炎运动和减肥的临床试验进行了系统评价。
在MEDLINE、EMBASE、PASCAL数据库中进行电子检索，对Cochrane综述进行系统检索，在指南中进行手动检索、荟萃分析并识别相关文章。
我们识别出83项试验，其中只有2项针对年龄≥75岁的患者；因此，我们将平均年龄阈值降至70岁，发现了15项试验，主要在膝关节骨关节炎患者和门诊患者中进行。
体育锻炼8项试验：对疼痛和功能有效（4项对照试验），仅在自我康复的情况下有持续效果。
水上运动5项试验：与陆上运动效果相同。
减肥2项试验：只有饮食+运动的患者症状有显著改善。
我们的系统评价证实，国际上关于膝关节骨关节炎运动的建议也适用于70-80岁的人群。长期有效性需要维持策略。鉴于这些高龄患者更容易出现药物相关的医源性问题，针对患有各种合并症的高龄患者进行特定试验是必要的。
