Coleman E A, Buchner D M, Cress M E, Chan B K, de Lateur B J
Department of Medicine, University of Washington, Seattle 98195-7660, USA.
J Am Geriatr Soc. 1996 Jan;44(1):14-21. doi: 10.1111/j.1532-5415.1996.tb05632.x.
The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program.
A population-based, single blinded, randomized controlled trial with three exercise groups and one control group.
A large urban health maintenance organization.
Older men and women (N = 105) aged 68 to 85, with leg strength below the 50th percentile for their age, sex, height, and weight and without neuromuscular disease or active cardiovascular disease.
Supervised exercise in 1-hour sessions, three times each week, for 24 to 26 weeks. One exercise group did strength training (ST) using weight machines (n = 25); another group did endurance training (ET) using stationary cycles (n = 25); and the third group did combined strength training and endurance training (ST+ET) (n = 25). The control group (n = 30) received no intervention.
Strength was measured at the ankle, knee, hip, and elbow using an isokinetic dynamometer. Joint symptoms were rated on a 6-point scale (0 = none, 5 = severe). Arthritis severity was based on self-reported use of arthritis medication. Health status was measured with subscales of the SF-36 and Sickness Impact Profile (SIP).
Joint symptoms fluctuated over time in all exercise groups, but they did not improve or worsen significantly in any group. The physical dimension of the SIP and SF-36 subscale scores, including Bodily Pain Scores, did not change over time in any group. Subjects with arthritis and joint symptoms gained as much strength with strength training as did subjects without joint symptoms. Adjustment for age, gender, baseline strength, adherence, and exercise group did not affect this finding. The rate of minor musculoskeletal injuries was 2.2 injuries per 1000 exercise hours.
Moderate intensity stationary cycle exercise and vigorous intensity strength training do not appear to produce or exacerbate joint symptoms in older adults. Joint symptoms did not explain the large variation in gains in strength in older adults participating in a standardized strength training exercise program. Musculoskeletal injuries occurred relatively infrequently, and no major injuries occurred. In evaluating joint pain that occurs in older adults in well regulated exercise programs, clinicians should consider other etiologies before attributing pain to exercise per se.
本研究的目的是确定运动是否会加重有骨关节炎病史的老年人的关节症状，或在无此类病史的老年人中引发症状。此外，我们还研究关节症状是否能解释在进行高强度力量训练运动的老年人中观察到的力量增长的巨大差异，并报告开始运动计划后肌肉骨骼损伤的发生率。
一项基于人群的单盲随机对照试验，有三个运动组和一个对照组。
一个大型城市健康维护组织。
年龄在68至85岁之间的老年男性和女性（N = 105），其腿部力量低于同年龄、性别、身高和体重人群的第50百分位数，且无神经肌肉疾病或活动性心血管疾病。
每周三次，每次1小时的监督运动，持续24至26周。一个运动组使用重量器械进行力量训练（ST）（n = 25）；另一组使用固定自行车进行耐力训练（ET）（n = 25）；第三组进行力量训练和耐力训练相结合的训练（ST + ET）（n = 25）。对照组（n = 30）不接受干预。
使用等速测力计测量踝关节、膝关节、髋关节和肘关节的力量。关节症状采用6分制评分（0 = 无，5 = 严重）。关节炎严重程度基于自我报告的关节炎药物使用情况。健康状况用SF - 36和疾病影响量表（SIP）的子量表进行测量。
所有运动组的关节症状随时间波动，但任何一组均未出现明显改善或恶化。SIP和SF - 36子量表评分的身体维度，包括身体疼痛评分，在任何一组中均未随时间变化。有骨关节炎和关节症状的受试者通过力量训练获得的力量与无关节症状的受试者相同。对年龄、性别、基线力量、依从性和运动组进行调整后，这一发现不受影响。轻微肌肉骨骼损伤的发生率为每1000运动小时2.2次损伤。
中等强度的固定自行车运动和高强度的力量训练似乎不会在老年人中产生或加重关节症状。关节症状并不能解释参与标准化力量训练计划的老年人力量增长的巨大差异。肌肉骨骼损伤相对较少发生，且未发生重大损伤。在评估在规范运动计划中出现关节疼痛的老年人时，临床医生在将疼痛归因于运动本身之前应考虑其他病因。
