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Exercise Before Surgery
By Bonnie Prescott
Beth Israel Deaconess Medical Center StaffThere’s no question that for patients suffering from severe osteoarthritis, joint replacement surgery can significantly reduce their pain and increase their strength and mobility, enabling them to lead fuller, more active lives.“Most patients with severe osteoarthritis can be extremely limited by their disease,” says Dr. Daniel Rooks, a clinical researcher in the division of rheumatology at Beth Israel Deaconess Medical Center. “They have trouble walking, which makes it difficult for them to perform many daily activities, including shopping and family and professional roles. I know of one patient who actually arranged her schedule so that she would only have to use the stairs in her home once a day.”The person who is physically fit is often thought to be better prepared for undergoing surgery. Now, a study by Dr. Rooks and his colleagues recently published in the medical journal Arthritis Care & Research offers evidence that exercise before total hip and knee replacement surgery can help patients maintain their functional abilities and improve their muscle strength while they await surgery, and can also reduce their odds of needing a stay in a rehabilitation hospital after surgery.The researchers studied 108 men and women (average age, 65) who were scheduled for either total hip replacement surgery or total knee replacement surgery. The participants were separated into two groups, half of whom took part in specially tailored one-hour exercise routines three times a week for a total of six weeks.“Beginning with gentle water-based activities, the group of exercisers progressed to moderate-level workouts using stationary bicycles, weight-training movements, abdominal strengthening exercises and stretching,” says Dr. Rooks.The second group did not engage in any exercise at all.After six weeks – and before they underwent their surgeries – the two groups were assessed by the researchers.“We found that the participants had responded very well to the exercise program,” says Dr. Rooks. “The hip-replacement surgery patients were able to stabilize both their pain and their level of function prior to surgery.” In addition, both total hip and total knee replacement patients gained muscle strength. Among the non-exercisers, he adds, both pain levels and their functional abilities worsened.The patients were then reassessed by the researchers at eight and 26 weeks after their surgeries. And the post-surgery differences between the exercisers and non-exercisers were even more dramatic.“The exercisers had a significantly reduced rate of inpatient rehabilitation following surgery –they were 73 percent more likely to go directly home from the hospital than were the non-exercisers [who went to rehabilitation facilities]” says Dr. Rooks. They also were able to walk unassisted a distance of more than 50 feet more often than the non-exercisers, and reported feeling more physically and mentally prepared for their recovery period.“The study findings suggest that being physically active before surgery gives you an advantage,” says Dr. Rooks. “Even people with severe osteoarthritis were still able to do enough exercise to improve their strength by as much as 20 percent – without suffering any injuries. Furthermore, these individuals expressed confidence in their abilities and felt better about themselves, which can make a tremendous difference.”What is Osteoarthritis? Osteoarthritis develops when cartilage is worn away. Cartilage is the tissue that covers the ends of bones, enabling the bones to easily glide over one another so that the joints can easily move. Without cartilage, bones can rub directly against one another, resulting in pain, swelling and loss of joint motion. Over time, further complications can develop if the joint loses its normal shape or if bone spurs grow on the ends of the joints.Osteoarthritis most often affects older individuals, though younger people who have suffered joint injuries may also be prone to developing the disease, which primarily affects the hands, knees, hips and spine.Warning signs of osteoarthritis include:
Beth Israel Deaconess Medical Center StaffThere’s no question that for patients suffering from severe osteoarthritis, joint replacement surgery can significantly reduce their pain and increase their strength and mobility, enabling them to lead fuller, more active lives.“Most patients with severe osteoarthritis can be extremely limited by their disease,” says Dr. Daniel Rooks, a clinical researcher in the division of rheumatology at Beth Israel Deaconess Medical Center. “They have trouble walking, which makes it difficult for them to perform many daily activities, including shopping and family and professional roles. I know of one patient who actually arranged her schedule so that she would only have to use the stairs in her home once a day.”The person who is physically fit is often thought to be better prepared for undergoing surgery. Now, a study by Dr. Rooks and his colleagues recently published in the medical journal Arthritis Care & Research offers evidence that exercise before total hip and knee replacement surgery can help patients maintain their functional abilities and improve their muscle strength while they await surgery, and can also reduce their odds of needing a stay in a rehabilitation hospital after surgery.The researchers studied 108 men and women (average age, 65) who were scheduled for either total hip replacement surgery or total knee replacement surgery. The participants were separated into two groups, half of whom took part in specially tailored one-hour exercise routines three times a week for a total of six weeks.“Beginning with gentle water-based activities, the group of exercisers progressed to moderate-level workouts using stationary bicycles, weight-training movements, abdominal strengthening exercises and stretching,” says Dr. Rooks.The second group did not engage in any exercise at all.After six weeks – and before they underwent their surgeries – the two groups were assessed by the researchers.“We found that the participants had responded very well to the exercise program,” says Dr. Rooks. “The hip-replacement surgery patients were able to stabilize both their pain and their level of function prior to surgery.” In addition, both total hip and total knee replacement patients gained muscle strength. Among the non-exercisers, he adds, both pain levels and their functional abilities worsened.The patients were then reassessed by the researchers at eight and 26 weeks after their surgeries. And the post-surgery differences between the exercisers and non-exercisers were even more dramatic.“The exercisers had a significantly reduced rate of inpatient rehabilitation following surgery –they were 73 percent more likely to go directly home from the hospital than were the non-exercisers [who went to rehabilitation facilities]” says Dr. Rooks. They also were able to walk unassisted a distance of more than 50 feet more often than the non-exercisers, and reported feeling more physically and mentally prepared for their recovery period.“The study findings suggest that being physically active before surgery gives you an advantage,” says Dr. Rooks. “Even people with severe osteoarthritis were still able to do enough exercise to improve their strength by as much as 20 percent – without suffering any injuries. Furthermore, these individuals expressed confidence in their abilities and felt better about themselves, which can make a tremendous difference.”What is Osteoarthritis? Osteoarthritis develops when cartilage is worn away. Cartilage is the tissue that covers the ends of bones, enabling the bones to easily glide over one another so that the joints can easily move. Without cartilage, bones can rub directly against one another, resulting in pain, swelling and loss of joint motion. Over time, further complications can develop if the joint loses its normal shape or if bone spurs grow on the ends of the joints.Osteoarthritis most often affects older individuals, though younger people who have suffered joint injuries may also be prone to developing the disease, which primarily affects the hands, knees, hips and spine.Warning signs of osteoarthritis include:
- stiffness in a joint after getting out of bed or sitting for a long time;
- swelling or tenderness in one or more joints;
- a “crunching” sound or feeling when bone rubs on bone.
