Ea. Coleman et al., THE RELATIONSHIP OF JOINT SYMPTOMS WITH EXERCISE PERFORMANCE IN OLDERADULTS, Journal of the American Geriatrics Society, 44(1), 1996, pp. 14-21
OBJECTIVES: The objective of this study is to determine if exercise in
creases joint symptoms in older adults with a history of arthritis or
produces symptoms in older adults without such history. In addition, w
e examine whether joint symptoms explain the large observed variation
in strength gain in older adults undergoing vigorous strength training
exercise, and report the incidence of musculoskeletal injuries upon i
nitiation of an exercise program. DESIGN: A population-based, single b
linded, randomized controlled trial with three exercise groups and one
control group. SETTING: A large urban health maintenance organization
. PARTICIPANTS: Older men and women (N = 105) aged 68 to 85, with leg
strength below the 50th percentile for their age, sex, height, and wei
ght and without neuromuscular disease or active cardiovascular disease
. INTERVENTIONS: Supervised exercise in 1-hour sessions, three times e
ach week, for 24 to 26 weeks. One exercise group did strength training
(ST) using weight machines (n = 25); another group did endurance trai
ning (ET) using stationary cycles (n = 25); and the third group did co
mbined strength training and endurance training (ST+ET) (n = 25). The
control group (n = 30) received no intervention. MEASUREMENTS: Strengt
h was measured at the ankle, knee, hip, and elbow using an isokinetic
dynamometer. Joint symptoms were rated on a 6-point scale (0 = none, 5
= severe). Arthritis severity was based on self-reported use of arthr
itis medication. Health status was measured with subscales of the SF-3
6 and Sickness Impact Profile (SIP). RESULTS: Joint symptoms fluctuate
d over time in all exercise groups, but they did not improve or worsen
significantly in any group. The physical dimension of the SIP and SF-
36 subscale scores, including Bodily Pain Scores, did not change over
time in any group. Subjects with arthritis and joint symptoms gained a
s much strength with strength training as did subjects without joint s
ymptoms. Adjustment for age, gender, baseline strength, adherence, and
exercise group did not affect this finding. The rate of minor musculo
skeletal injuries was 2.2 injuries per 1000 exercise hours. CONCLUSION
S: Moderate intensity stationary cycle exercise and vigorous intensity
strength training do not appear to produce or exacerbate joint sympto
ms in older adults. Joint symptoms did not explain the large variation
in gains in strength in older adults participating in a standardized
strength training exercise program. Musculoskeletal injuries occurred
relatively infrequently, and no major injuries occurred. In evaluating
joint pain that occurs in older adults in well regulated exercise pro
grams, clinicians should consider other etiologies before attributing
pain to exercise per se.