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Open Rheumatol J. 2014 Nov 28;8:89-95. doi: 10.2174/1874312901408010089. eCollection 2014.

Physical exercise and weight loss for hip and knee osteoarthritis in very old patients: a systematic review of the literature.

Author information

1
Service de Médecine Gériatrique 3 [Department of Geriatric Medicine 3], Hôpital Sainte-Périne (A.P-H.P), Paris, France.
2
Pôle Vieillissement, réadaptation et Accompagnement [Centre for the Aged, Rehabilitation and Support], Hôpital Paul Brousse (A.P-H.P) Villejuif, France.
3
Medical Office, Paris, France.
4
Service de Rhumatologie [Department of Rheumatology], Groupe Hospitalier Paris Saint Joseph, Paris, France.
5
Centre Hospitalier, Le Mans, France.
6
Centre de Médecine Interne Gériatrique [Centre for Geriatric Internal Medicine], Centre Hospitalier régional, Orléans, France.
7
Service de Médecine interne et Gériatrie [Department of Internal and Geriatric Medicine], Montpellier, France.
8
Service de Rhumatologie, Rheumatology Department, Medical Office / Hôpital Saint Antoine -A.P-H.P, Paris, France.

Abstract

BACKGROUND:

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.

METHODS:

Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

Hip osteoarthritis; knee; physical exercise; systematic review; very old; weight loss.

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