Aladdin H. Shadyab, PhD, MS, MPH, CPH, on Exercise Before Joint Replacement
Osteoarthritis is the most common form of arthritis and affects more than 30 million adults in the United States. Physical activity is often recommended as a treatment option for osteoarthritis, but it is unclear how this treatment option impacts the long-term mobility of patients who undergo total knee and hip replacement surgery.
Aladdin H. Shadyab, PhD, MS, MPH, CPH, a researcher in the Department of Family Medicine and Public Health at the University of California, San Diego, is the lead author of a recently published study1 about the topic and answered our questions about the outcomes of his research.
Rheumatology Consultant: So, how did your study come about?
Aladdin H. Shadyab: Total hip and knee replacements for osteoarthritis are 2 of the most commonly performed surgical procedures in the United States, and their use is expected to increase 4-fold in the next decade due to the aging population. However, there is limited research about how recipients of total hip and knee replacements age.
Few studies have followed total hip and knee replacement recipients prospectively for long periods of time to determine their mobility outcomes in late life.
Physical activity has been recommended for the successful management of osteoarthritis, and it has been shown to improve physical function among patients with osteoarthritis. However, it is unknown whether physical activity levels before total joint replacement are associated with long-term functional outcomes after undergoing surgery.
We performed a prospective study to determine whether higher physical activity levels before total joint replacement increased the likelihood of better mobility in late life among older women. Our study was conducted among postmenopausal women participating in the Women’s Health Initiative. Women reported their levels of physical activity at the first study visit, which sometimes took place several years before undergoing total hip or knee replacement for osteoarthritis.
Women were then followed to age 85 years to determine their mobility status in old age. Before our study, there were no data on late-life functional outcomes among women who underwent total hip or knee replacement for osteoarthritis.
RheumCon: The results of your study showed that women with lower physical activity levels before total joint replacement are more likely to experience mobility limitations later in life. What advice can rheumatologists give to their patients to combat this outcome?
AHS: Our findings showed that women who were physically inactive before undergoing total hip or knee replacement for osteoarthritis had the highest risk of mobility limitation compared with women who had the highest amount of physical activity. There were significant dose-response associations of physical activity with late-life mobility limitation in our study, suggesting that the less women exercised, the greater the risk of mobility limitation.
Patients should consult with their rheumatologists on the optimal treatment plan that involves physical activity. Based on current recommendations, the benefits of physical activity in the setting of osteoarthritis include attenuation of joint loading, maintenance of joint stability, and assistance with joint motion and elasticity of periarticular tissues, all of which are important to maintaining function. Further studies are needed to determine how patterns of physical activity before total hip or knee replacement influence late-life functional health.
RheumCon: For patients who have too much pain to move (before or after surgery), increasing their physical activity is a challenge. How would you treat these challenging patients?
AHS: According to the Centers for Disease Control and Prevention, participating in physical activity can improve pain, function, mood, and quality of life among arthritis patients. Engaging in a physically active lifestyle may also delay disability due to arthritis. It is recommended that arthritis patients participate in low-impact, joint-friendly activities, such as walking, biking, and swimming. Arthritis patients with pain should “start slow” and should exercise less frequently to manage their pain. They may also try different types of exercises that place less pressure on the joints, such as water aerobics. Patients should consult with their rheumatologists to manage their activity levels based on their arthritis symptoms.
RheumCon: What is the next step in your research?
AHS: Future studies are needed to examine large cohorts of aging patients with total hip and knee replacements. Because our population is aging, the use of total hip and knee replacements will only continue to increase. Therefore, examining long-term functional health among total joint replacement recipients should be a public health priority.
—Danielle Schipani
Reference:
1. Shadyab AH, Eaton CB, Li W, LaCroix AZ. Association of physical activity with late-life mobility limitation among women with total joint replacement for knee or hop osteoarthritis. J Rheumatol. 2018;45(8):1180-1187. https://doi.org/10.3899/jrheum.171136.