There is a duty on doctors in the civilized world to remain abreast of current developments in the field of medicine. The same goes for Thailand with Continuous Medical Education (CME) promoted by the better hospitals.
While doing my own CME the other day, I came across a most interesting study on Osteo Arthritis (OA) of the knee. This was made even more interesting for me, in the fact that I do have OA knee, and indeed required operation for this last year.
In the article, which was printed in “Arthritis Care and Research”, Dr. Daniel K. White stated that patients with knee OA can gain significant benefits and avoid physical function limitations by simply walking more.
Now my experience in clinical medicine has always been that as OA develops, the pain in the knees result in less walking, quite the reverse of this scientific study.
Dr. White expressed the opinion that, “As clinicians, we should be promoting walking in our patients with knee OA. We should have them measure their physical activity with a pedometer, much like people measure their weight with a scale. Those starting on a walking program should get to a target of at least 3000 steps/day and ultimately try to reach 6000 steps/day. This is well below the popular anecdote of 10,000 steps/day, which may be good news to those starting out. It doesn’t take much to get to 3000 steps/day.” Dr. White is a research assistant professor at the Department of Physical Therapy and Athletic Training, Boston University College of Health and Rehabilitation Sciences, Massachusetts.
The researchers measured daily steps taken by 1788 people with or at risk for knee OA who were part of the Multicenter Osteoarthritis Study, a large multicenter longitudinal cohort study of community-dwelling adults. Mean age was 67 years, mean body mass index was 31 kg/m2, and 60 percent of participants were women.
The researchers measured the number of steps patients walked with an ankle monitor for 7 days. They measured functional limitation at baseline and again 2 years later. The researchers defined functional limitation as a walking speed of less than 1.0 m/s or Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function score of 28 or greater out of 68.
The authors reported the minimum for preventing functional decline was between 3250 and 3700 steps/day. Walking an additional 1000 steps each day was associated with a 16 percent to 18 percent reduction in incident functional limitation 2 years later.
“Our findings add to [the] notion that walking is good for people with knee OA. Specifically, walking that occurs during unstructured activities, a few steps here and there, add up and do seem to make a difference in terms of prevention of functional limitation in this patient population. I hope that these findings will lead to clinicians encouraging their patients to use a pedometer to measure their physical activity and work towards the 3000 then 6000 steps/day goal,” Dr. White said.
Another researcher in Italy concluded that physical activity stimulates the expression of lubricin, a lubricant molecule of synovial fluid that is important for cartilage trophism and that contributes to the delay of OA development.
So the answer to OA is to try and increase the number of steps per day until you can get to 6000 steps if possible. Find a route you can safely walk on, count the steps once and then work on from there. I do follow the keep active regimen myself, and whilst not actually counting the steps I walk briskly around the hospital, as many of you have even remarked to me.
On the same day I came across a study which has claimed people with the two most common types of cancer can cut their risk of dying by up to 40 percent – simply by walking 1.6 km every day.
Research carried out by Macmillan Cancer Support claims walking for 1.6 km at a moderate pace of up to 5 km per hour, or walking for around 20 minutes a day could reduce breast cancer patients’ risk of dying by around 40 percent and those with prostate cancer by 30 percent.
So there’s the answer – buy a dog!