The relationship between exercise and osteoarthritis in the elderly.

OBJECTIVES: To review within a prescribed evidence-based framework (1) the relationship between intermittent or lifelong physical activity and the subsequent onset or progression of osteoarthritis (OA) in later life and (2) the effect of structured exercise routines on the management of OA in the elderly. DATA SOURCES: A systematic literature search of MEDLINE (1950 to April Week 2, 2008) and EMBASE (1980 to 2008 Week 16) was carried out using the Ovid interface. Relevant mapped terms addressing the identified objectives were combined and exploded according to a defined protocol. STUDY SELECTION: Studies that met relevancy criteria and were of high methodologic quality (prospective cohort studies for the risk factor component and systematic reviews and randomized controlled trials for the therapy component) were extracted and then hand searched for any additional studies. Final inclusion was based on agreement between two independent assessors, according to prescribed criteria. Any studies that were not in the English language, did not address the questions of interest in humans, or did not include a population that had at least a mean age of 55 years at the time of study termination, were excluded. Only land-based regimens were included in the therapy component of the review. DATA EXTRACTION: Pertinent information on subjects, risks, and outcomes (when assessing physical activity as a risk factor for OA in the elderly) and subjects, interventions, and outcomes (when evaluating the application of exercise in the management of OA in older persons) was extracted from the selected studies. DATA SYNTHESIS: Ten studies met entry criteria for examining the relationship between physical activity and the development or progression of OA. Likely because of study variations and differences in the nature, duration and intensities of exercise regimens, no clearcut consensus was apparent on whether or not physical activity was a risk factor for OA. Six scientific reviews and ten single blinded randomized controlled trials were included when evaluating the effect of exercise on OA management. Regardless of wide variability in the included studies, a majority demonstrated that structured exercise programs were effective in the management of older subjects with OA. CONCLUSIONS: : Nuances of study design, differences in age and type of target populations, variability in the intensity, duration, and nature of physical activity in the respective studies, and lack of standardization in the way radiographic data are interpreted are among the factors that prevent consensus regarding the effect of physical activity on later development of OA. Similarly, there is considerable heterogeneity in the studies that assessed exercise in the treatment of OA. Nonetheless, there is substantive evidence in support of the benefits of one or another strength training or aerobic exercise regimen in the management of OA in middle-aged and elderly subjects.

Is regular exercise a friend or foe of the aging immune system? A systematic review.

OBJECTIVE: The purpose of the current review is to synthesize the available evidence from prospective clinical trials that are relevant to the clinical question: "What, if any, are the effects of regular aerobic and/or resistance exercise on the immune system in healthy older adults?" DATA SOURCES: Electronic databases were searched, using terms pertaining to immunology, exercise, and aging. Using the Ovid interface, the following databases were explored: Allied and Complimentary Medicine (AMED) (1985 to 2008), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2008), all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED), EMBASE (1980 to 2008), and MEDLINE (1950 to 2008). The MEDLINE database was searched a second time through the PubMed interface. STUDY SELECTION: Prospective controlled clinical trials were selected for review if they investigated the effects of an exercise intervention (minimum 4 weeks in duration) on an immune outcome measure in an older but otherwise healthy population. A total of 19 articles representing 17 trials were identified. DATA EXTRACTION: Quality assessment of the relevant articles was performed using the Jadad et al criteria. Data extraction was performed using a standardized instrument. Data regarding the participants, interventions, and laboratory and clinical immunologic outcomes were synthesized. DATA SYNTHESIS: Available data provide no clear evidence of acute or chronic effects of exercise on lymphocyte or natural killer (NK) cell numbers or phenotype (ie, surface markers)/activity, with 2 exceptions: (1) strength or endurance exercise may cause an acute transient elevation in circulating CD8+ T cells, and (2) regular aerobic exercise appears to enhance immunologic memory in the context of vaccination. The effects of strength training on NK cell activity are unclear. Furthermore, regular aerobic exercise appears to be associated with a reduction in chronic inflammation. Finally, no prospective controlled trials have clearly documented clinical immunologic benefits of regular exercise, which may well relate to underpowering of these studies. CONCLUSIONS: Overall, in healthy older adults, regular, particularly aerobic, exercise appears to be a friend of the immune system, helping to offset diminished adaptive responses and chronic inflammation. The possibility exists that particularly strenuous exercise may cause acute immunologic changes, such as diminished NK cell activity, which could predispose to infection in certain individuals. However, given the possible benefits of regular exercise on the immune system and the many definite benefits on other systems, the evidence presented here should not dissuade practitioners from suggesting regular exercise to otherwise healthy older adults.

How "soft" are soft neurological signs? The relationship of subjective neuropsychiatric complaints to cognitive function in systemic lupus erythematosus.

OBJECTIVE: As part of a longitudinal study of cognitive function in systemic lupus erythematosus (SLE), we documented the range and frequency of subjective neurologic and/or psychiatric (NP) complaints in Never-NP-SLE patients, and related these to cognitive function, using the latter as a primary indicator of nervous system involvement. METHODS: Thirty patients with SLE who did not have major neurologic and psychiatric involvement underwent baseline and followup neuropsychological testing roughly 5 years apart. Within 0-13 months prior to retesting, each patient completed a 42 item questionnaire recording NP symptoms. RESULTS: The group as a whole endorsed 26% of symptoms. Fourteen patients labelled high endorsers (> 35% of items) endorsed, on average, 42% of symptoms. There was a significant association between higher item endorsement and lower cognitive function (r = -0.46, p < 0.02) and significantly poorer cognitive performance in the high compared to low endorser groups (t = -3.07, p < 0.005). In addition, a subset of 8 items was endorsed at least twice as often by SLE patients as by patients with rheumatoid arthritis (n = 12) or healthy controls (n = 10). CONCLUSION: These results suggest that "minor" NP symptoms and, in particular, a small subset of subjective complaints may be sufficient to raise suspicion of subclinical nervous system involvement in the absence of clinically evident NP-SLE.