Department of Medicine, Baylor College of Medicine, Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, and Michael E. DeBakey Medical Center, Houston, Texas.
Department of Medicine, Baylor College of Medicine, Houston, Texas.
Arthritis Rheumatol. 2022 Oct;74(10):1660-1667. doi: 10.1002/art.42241. Epub 2022 Sep 1.
To assess the relationship between walking for exercise and symptomatic and structural disease progression in individuals with knee osteoarthritis (OA).
We assessed a nested cohort of participants age 50 years or older within the Osteoarthritis Initiative, a community-based observational study in which subjects were enrolled between 2004 and 2006. We focused on 4 dichotomous outcomes from baseline to the 48-month visit, involving determination of the frequency of knee pain and radiographic severity of knee OA on posteroanterior semiflexed knee radiographs. The outcomes assessed included 1) new frequent knee pain, 2) worsening of radiographic severity of knee OA based on the Kellgren/Lawrence grade, 3) progression of medial joint space narrowing, and 4) improved frequent knee pain. We used a modified version of the Historical Physical Activity Survey Instrument to ascertain those subjects who reported walking for exercise after age 50 years. The survey was administered at the 96-month visit (2012-2014).
Of 1,212 participants with knee OA, 45% were male and 73% reported walking for exercise. The mean ± SD age was 63.2 ± 7.9 years, and the mean ± SD body mass index was 29.4 ± 4.6 kg/m . The likelihood of new frequent knee pain was reduced in participants with knee OA who walked for exercise as compared to those who were non-walkers (odds ratio [OR] 0.6, 95% confidence interval [95% CI] 0.4-0.8), and progression of medial joint space narrowing was less common in walkers compared to non-walkers (OR 0.8, 95% CI 0.6-1.0).
In individuals with knee OA who were age 50 years or older, walking for exercise was associated with less frequent development of knee pain. These findings support the notion that walking for exercise should be encouraged for people with knee OA. Furthermore, we offer a proof of concept that walking for exercise could be disease modifying, which warrants further study.
评估锻炼性步行与膝骨关节炎（OA）患者症状和结构疾病进展之间的关系。
我们评估了 Osteoarthritis Initiative 中年龄在 50 岁或以上的参与者的嵌套队列，这是一项基于社区的观察性研究，其中参与者于 2004 年至 2006 年期间入组。我们主要关注从基线到 48 个月随访期间的 4 个二分类结局，涉及确定膝关节疼痛的频率和后前半屈膝关节 X 线片上膝关节 OA 的放射学严重程度。评估的结局包括 1）新出现的频繁膝关节疼痛，2）根据 Kellgren/Lawrence 分级确定的膝关节 OA 放射学严重程度恶化，3）内侧关节间隙狭窄进展，4）频繁膝关节疼痛改善。我们使用改良版的历史体力活动调查仪器来确定那些 50 岁以后报告锻炼性步行的受试者。该调查于 96 个月随访时（2012-2014 年）进行。
在 1212 名患有膝骨关节炎的参与者中，45%为男性，73%报告有锻炼性步行。平均年龄为 63.2±7.9 岁，平均 BMI 为 29.4±4.6 kg/m²。与非步行者相比，进行锻炼性步行的膝骨关节炎患者出现新的频繁膝关节疼痛的可能性较低（比值比 [OR] 0.6，95%置信区间 [95%CI] 0.4-0.8），且内侧关节间隙狭窄进展在步行者中较非步行者少见（OR 0.8，95%CI 0.6-1.0）。
在年龄在 50 岁或以上的膝骨关节炎患者中，锻炼性步行与膝关节疼痛的发生频率较低有关。这些发现支持了这样一种观点，即应鼓励膝骨关节炎患者进行锻炼性步行。此外，我们提供了一个概念验证，即锻炼性步行可能具有疾病修饰作用，这值得进一步研究。
