Osteoarthritis? “Regular recreational exercise is good for the joints.”
Faculty of Sport and Exercise Medicine Speaks at the British Orthopaedic Association
The British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA) invited the Faculty of Sport and Exercise Medicine to share its session on Sport and Osteoarthritis at its 2013 meeting.
Many surgeons may advise activity modification and reduction of load bearing exercise in the presence of degenerate pathology. This reduction in physical activity may well lead to the further problems comparable to smoking, diabetes and obesity.
President of the Faculty of Sport and Exercise Medicine, Rod Jacques, recommended a session to discuss this, led by the Arthritis Research UK group: Professor Mark Batt, Professor Nigel Arden and Dr Julia Newton. The room was quickly filled with an audience of 172 delegates, leaving standing room only.
Professor Nigel Arden commenced the session by discussing;“Whether exercise causes osteoarthritis (OA) and how we may never know the answer?” Professor Arden reminded us all that osteoarthritis is a heterogenic disease and research should focus on clinically symptomatic rather than just radiographic OA. It is important to separate out the effects of exercise from injury and sport related factors. There is little evidence to suggest that regular recreational exercise is anything but good for the joints. Many in the audience will remember his explanation of meta-analysis: the grouping together of studies with unclear outcomes, may not provide an answer, but will produce a larger paper with a poor outcome.
Past President of the Faculty of Sport and Exercise Medicine, Professor Mark Batt, outlined: “ What exercise minimises the risk of osteoarthritis in adults?” He pointed out that when the physical activity guidelines (150 minutes per week) are met, there is no associated risk with incident knee osteoarthritis, runners do not have an especially high risk of OA compared to non-runners and therefore, as a consequence, running does not cause OA and does not wear out joints. There is an addition and a strong interplay between the genes and the environment, the strongest factors being obesity, family history, gender and injury. In terms of exercise recommendation or prescription for our patients Professor Batt recommended cross training, the consideration of non-impact loading, if appropriate, and attempts to avoid significant acute injury with sports that frequently involve direction changes or collision. Mark’s final thoughts were about the understanding of family history and the importance of avoiding being overweight.
The final speaker representing the Faculty was Dr Julia Newton, a Sports and Exercise Medicine Consultant from Oxford, giving us guidance on: “What exercise is best in managing adults with established osteoarthritis?” Three quarters of patients in Julia’s practice with lower limb osteoarthritis are managed conservatively, without arthroplasty. Patients with osteoarthrtitis have an increased SMR for all cause mortality. Exercise has a significant effect on pain and function in 50-75% patients, comparable exercise has effect size on pain equivalent to taking NSAIDs without the side effects. Exercise prescription should be a combination of aerobic, strength and balance work to target co-morbidity and other risks of inactivity as well as the osteoarthritis.
The session then turned towards how to minimize the risk of osteoarthrtitis and surgical reconstruction. Simon Roberts, BOSTAA’s long serving honorary secretary, presented on the shoulder showing radiographs of his own shoulder. Possibly this could have been predisposed by too much arthroscopy!
Professor Fares Haddad, at the Institute of Sports, Exercise and Health, presented some of his outcome data related to his study‘Osteoarthritis following the tear to knee ligament’ and promoted the developing UK Knee Ligament Registry.
Lastly, Professor Nicola Maffulli discussed some of the outcomes of ankle ligament instability featuring anatomic and non-anatomic lateral ligament reconstruction.
After more questions linking the surgical treatment of sports injury and on-going exercise, the session was brought to a close. BOSTAA would like to thank its colleagues from the Faculty of Sports and Exercise Medicine and hopes this is a collaboration that can be continued in the future.
Mr Mike Carmont
News released by the British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA)
Figure legend: Panos Thomas, Mark Batt, Mike Carmont, Fares Haddad, Julia Newton, Simon Roberts and Nigel Arden at the British Orthopaedic Association October 2013.