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Physical Exercise and the Prevention of Disability in Activities of Daily Living in Older Persons With Osteoarthritis
Brenda W. J. H. Penninx, PhD;
Stephen P. Messier, PhD;
W. Jack Rejeski, PhD;
Jeff D. Williamson, MD, PhD;
Mauro DiBari, MD, PhD;
Chiara Cavazzini, MD;
William B. Applegate, MD;
Marco Pahor, MD
Arch Intern Med. 2001;161:2309-2316.
Background The prevention of disability in activities of daily living (ADL) may
prolong older persons' autonomy (older persons are defined in this study as
those aged  60 years). However, proved preventive strategies for ADL disability
are lacking. A sedentary lifestyle is an important cause of disability. This
study examines whether an exercise program can prevent ADL disability.
Methods A 2-center, randomized, single-blind, controlled trial was conducted
in which participants were assigned to an aerobic exercise program, a resistance
exercise program, or an attention control group. Of the 439 community-dwelling
persons aged 60 years or older with knee osteoarthritis originally recruited,
the 250 participants initially free of ADL disability were used for this study.
Incident ADL disability, defined as developing difficulty in transferring
from a bed to a chair, eating, dressing, using the toilet, or bathing, was
assessed quarterly during 18 months of follow-up.
Results The cumulative incidence of ADL disability was lower in the exercise
groups (37.1%) than in the attention control group (52.5%) (P = .02). After adjustment for demographics and baseline physical function,
the relative risk of incident ADL disability for assignment to exercise was
0.57 (95% confidence interval, 0.38-0.85; P = .006).
Both exercise programs prevented ADL disability; the relative risks were 0.60
(95% confidence interval, 0.38-0.97; P = .04) for
resistance exercise and 0.53 (95% confidence interval, 0.33-0.85; P = .009) for aerobic exercise. The lowest ADL disability risks were
found for participants with the highest compliance to exercise.
Conclusions Aerobic and resistance exercise may reduce the incidence of ADL disability
in older persons with knee osteoarthritis. Exercise may be an effective strategy
for preventing ADL disability and, consequently, may prolong older persons'
autonomy.
From the Sticht Center on Aging, Department of Internal Medicine, Wake
Forest University School of Medicine (Drs Penninx, Williamson, DiBari, Applegate,
and Pahor), and the Department of Health and Exercise Sciences, Wake Forest
University (Drs Messier and Rejeski), Winston-Salem, NC; and the Department
of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliera
"Careggi," Florence (Dr DiBari), and the Section of Geriatrics, University
of Rome "Tor Vergata," Rome (Dr Cavazzini), Italy.
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