重量訓練以及自我管理計畫有助於早期骨關節炎病患


  【24drs.com】January 7, 2010 — 研究者在2010年1月號關節炎照護與研究(Arthritis Care & Research)期刊中報告指出,重量訓練以及自我管理計畫對於有早期症狀之膝蓋骨關節炎(osteoarthritis,OA)、活力不佳之中年患者有相似的幫助。
  
  OA是美國最常見的關節炎,也高居造成失能原因的第2名,目前,是婦女最盛行的慢性疾病:65歲左右婦女有35%到45%有OA。
  
  有一些研究顯示,有氧運動以及阻力運動和自我管理計畫都有幫助,但是這些研究多數的研究對象是長期疾病、OA嚴重度較高、功能不佳較嚴重的病患,因此無法代表所有的膝蓋OA病患。
  
  維吉尼亞州大學的Patrick E. McKnight博士等人寫道,此外,關於重量訓練以及單純自我管理計畫的多面向治療方法的證據有限。
  
  他們寫道,因為兩種治療方式所呈現的生理和心理功能結果不同,我們假設,併用這兩種治療可以促進結果。
  
  研究目標是,評估併用重量訓練以及自我管理計畫對於改善早期膝蓋OA之男女病患的功能性結果的相關效果。
  
  亞利桑那大學關節炎中心進行了「The Multidimensional Intervention for Early Osteoarthritis of the Knee」這項研究,這個為期24個月的隨機無遮蔽(unblinded)試驗,包括了237名35-64歲的參與者,曾報告指出在多數時候有單側或兩側關節疼痛,且症狀期間小於5年。
  
  研究對象有Kellgren/Lawrence分類法等級2的X光證據顯示單側或兩側膝蓋OA,且自我報告在上下樓梯、行走、跪或日常活動中,有一種以上情況會引起膝蓋疼痛且造成失能。
  
  研究對象被隨機指派接受重量訓練、自我管理計畫、或併用這兩種。
  
  重量訓練包括最初9個月由專業體能訓練師監督的重量訓練課程,目標在核心區域的強度與平衡、動作與彎曲的範圍、以及等張肌肉強度。之後進行15個月的重量訓練課程,聚焦在發展自主長期運動習慣。
  
  自我管理計畫包括最初9個月的教育課程,由計畫管理者與地區健康專業人士協助,其中沒有重量訓練的員工,在這9個月中,病患每週會接到電話訪談,然後調整到每兩週、每月、每兩月進行電話訪談。
  
  隨機分派到併用組的病患,則同時接受重量訓練以及自我管理計畫。
  
  總共有201名病患(73.6%)完成這兩年的試驗,重量訓練的遵從度為55.8%,自我管理計畫為69.1%,併用組為59.6%。
  
  使用標準Cohen氏方法來計算效果大小,作者們發現,這三組從治療前到治療後,大腿推蹬(d, 0.85)、動作範圍(d, 1.00)、勞動能力(d, 0.60)、平衡(d, 0.59)與爬樓梯(d, 0.59)等生理功能測量都有顯著改善。
  
  此外,這三組的自我報告疼痛(d, -0.51)與失能(d, -0.55)都呈現減少。
  
  各組之間沒有顯著差異。
  
  作者們在討論中指出,併用治療的理由是,生理和心理治療等不同因素可能可以產生加成效果,這些結果則認為不然,三種治療方式並未顯示有差異,認為這三種方式在這兩年期間有相似的助益。
  
  作者們指出,研究限制包括,未評估對關節軟骨和發炎的治療效果,缺乏無治療的對照組,而未能判斷治療的直接效果。另外兩個限制是,各組的自我醫療可能會有差異,因為最初在男性研究對象招募上有困難,而缺乏適當的性別分類分析。最後,因為研究對象進入研究時的功能性不錯,因而使治療所呈現的效果有限。
  
  作者們結論表示,生理功能是維持健康體能活動所不可或缺的,我們的結果認為,重量訓練以及自我管理計畫對於早期OA病患可能有廣泛的健康助益。健康照護提供者可以有信心地建議OA病患採用自我管理與重量訓練,除非在取得上、費用上、負擔或偏好上有所限制。
  
  國家關節炎與肌肉骨骼和皮膚疾病研究中心支持本研究。McKnight博士報告無相關財務關係。
  
  Arthritis Res Ther. 2010;62:45-53.

Strength Training, Self-Management Programs Benefit Patients With Early Osteoarthritis

By Fran Lowry
Medscape Medical News

January 7, 2010 — Strength training and self-management provide similar benefits for physically inactive middle-aged people with early symptomatic osteoarthritis (OA) of the knee, researchers report in the January 2010 issue of Arthritis Care & Research.

OA is the most common form of arthritis and the second leading cause of disability in the United States. At this time, it is the most prevalent chronic condition among women: OA of the knee is present in 35% to 45% of women by age 65 years.

A number of studies have shown that aerobic and resistance exercise and self-management programs are of benefit, but most have been conducted in older patients with longer disease duration, greater OA severity, and greater functional impairment, and thus do not represent all patients with knee OA.

In addition, there is little evidence on the benefit of multidimensional treatments relative to strength training and self-management alone, write Patrick E. McKnight, PhD, from George Mason University, Fairfax, Virginia, and colleagues.

"Because both treatments may address physical and psychological functional outcomes differently, we hypothesized that combining the two treatments might enhance the outcomes," they write.

The aim of the study was to assess the relative effectiveness of combining self-management and strength training in improving functional outcomes in men and women with early knee OA.

The Multidimensional Intervention for Early Osteoarthritis of the Knee was conducted at the University of Arizona Arthritis Center, Tucson. The 24-month, unblinded, randomized trial included 273 participants between the ages of 35 and 64 years who reported pain in one or both knees on most days, and whose duration of symptoms was less than 5 years.

Study participants had Kellgren/Lawrence classification grade 2 radiographic evidence of knee OA in one or both knees and self-reported disability resulting from knee pain during one or more of the following: descending or ascending stairs, walking, kneeling, or performing daily activities.

Participants were randomly assigned to receive strength training, self-management, or a combination of these options.

Strength training consisted of an initial 9 months of strength training sessions supervised by expert physical trainers and targeting the core areas of stretching and balance, range of motion and flexibility, and isotonic muscle strength. This was followed by 15 months of strength training sessions focused on developing self-directed long-term exercise habits.

Self-management consisted of an initial 9 months of educational sessions that were facilitated by the program manager and local health professionals. No strength training treatment staff members were involved. Patients also received weekly telephone calls throughout the 9 months. These calls were tapered to biweekly, monthly, and bimonthly calls for the duration of the study period.

Patients randomly assigned to the combined group received both strength training and self-management programs.

A total of 201 participants (73.6%) completed the 2-year trial. Compliance was modest for the strength training (55.8%), self-management (69.1%), and combined (59.6%) programs.

Using the standard Cohen's d method to compute effect sizes, the authors found that the 3 groups showed a significant and large increase from pre- to posttreatment in all of the physical functioning measures, including leg press (d, 0.85), range of motion (d, 1.00), work capacity (d, 0.60), balance (d, 0.59), and stair climbing (d, 0.59).

In addition, all 3 groups showed decreased self-reported pain (d, ?0.51) and disability (d, ?0.55).

There were no significant differences among the groups.

"The logic behind the combined treatment was that the different factors addressed in physical and psychological treatments might produce an additive effect if administered together. These results suggest otherwise. Instead, the comparison of the 3 treatment arms showed no differences, suggesting similar benefits for all 3 over a 2-year period," the authors note in their discussion.

Limitations include no assessment of treatment effects on articular cartilage and inflammation and the lack of a no-treatment group, which precluded a direct test of treatment effectiveness. Possible differences in self-medication among the groups and lack of an adequate sex-stratified analysis resulting from difficulties recruiting men are 2 other limitations. Finally, the sample might have limited the effects of each treatment because participants were highly functioning at study entry, the authors note.

"Insofar as physical function is a prerequisite to maintaining health-protective levels of physical activity, our results suggest there may be broad health benefits from strength training and self-management for patients with early OA," the authors conclude. "Health care providers may confidently recommend self-management and strength training for their OA patients, constrained only by availability, costs, burden, or preference."

The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. McKnight has reported no relevant financial relationships.

Arthritis Res Ther. 2010;62:45-53.

    
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