Purpose The purpose of this study was to compare the effects of two different resistance exercise protocols on self-reported disability, fear avoidance beliefs, pain catastrophizing and back pain symptoms in obese, older adults with low back pain. Methods Obese adults (N=49; 60–85 years) with chronic low back pain (LBP) were randomized into a total body resistance exercise intervention (TOTRX), lumbar extensor exercise intervention (LEXT) or a control group (CON). Main outcomes included perceived disability (Oswestry Disability Index [ODI], Roland Morris Disability Questionnaire [RMDQ]). Psychosocial measures included the Fear Avoidance Beliefs (FAB) survey, Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS). LBP severity was measured during three functional tasks: walking, stair climb and chair rise using an 11 point numerical pain rating scale (NRSpain). Results The TOTRX group had greater reductions in self-reported disability scores due to back pain (ODI, RMDQ) compared to LEXT (p<0.05). The PCS scores decreased in the TOTRX compared to CON by month four (64.3% vs 4.8%, p<0.05). Pain severity during chair rise activity, and walking pain severity was decreased in both LEXT and TOTRX relative to the CON group. Conclusions Greater reductions in perceived disability due to LBP can be achieved with TOTRX compared to LEXT. Pain catastrophizing and pain severity decreased most with TOTRX. The positive change in psychological outlook may assist obese, older adults with chronic back pain re-consider the harmfulness of the pain and facilitate regular participation in other exercise programs.

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Objective This study determined whether kinesiophobia levels were different among older adults with chronic low back pain (LBP) and varying body mass index (BMI) and whether kinesiophobia predicted perceived disability or walking endurance. Design This study was a secondary analysis from a larger interventional study. Obese, older adults with LBP (N=55; 60-85 years) were participants in this study. Data were stratified based on BMI: overweight (25-29.9 kg/m2), obese (30-34.9 kg/m2) and severely obese (35 kg/m2). Participants completed a battery of surveys (modified Tampa Scale of Kinesiophobia [TSK-11], Fear Avoidance Beliefs [FAB], Pain Catastrophizing scale [PCS], and perceived disability measures of the Oswestry Disability Index [ODI], Roland Morris Disability Questionnaire [RMDQ]). Walking endurance time was captured using a symptom limited graded walking treadmill test. Peak LBP ratings were captured during the walk test. Results Walking endurance times did not differ by BMI group, but peak LBP ratings were higher in the moderate and severely obese groups compared to the overweight group (3.0 and 3.1 points vs. 2.1; p<0.05). There were no difference in the kinesiophobia scores (TSK-11, PCS, FAB work and activity subscores) or the perceived disability scores (ODI, RMD). However, adjusted regression analyses revealed that TSK-11 scores contributed 10-21% of the variance of the models pain with walking and perceived disability due to back pain. Kinesiophobia was not a significant contributor to the variance of the regression modeling for walking endurance. Conclusions In the obese older population with LBP, the TSK-11 might be a quick and simple measure to identify patients at risk for poor self-perception of functional ability The TSK and ODI may be quick useful measures to assess initial perceptions before rehabilitation. Kinesiophobia may be a good therapeutic target to address to help affected obese older adults fully engage in therapies for LBP.

Objective:This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA).Design:This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six.Materials and Methods:Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz.Results:HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044).Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.

Objective To compare the effects of 4 months of isolated lumbar resistance exercise and total body resistance exercise on walking performance in obese, older adults with chronic low back pain. A secondary analysis examined whether responsiveness to training modulated walking improvement. Design Randomized, controlled trial. Setting Research laboratory affiliated with tertiary care facility. Methods and Intervention Participants (N = 49; 60–85 years) were randomized into a 4-month resistance exercise intervention (TOTRX), lumbar extensor exercise intervention (LEXT), or a control group (CON). Main Outcome Measurements Walking performance, maximal low back strength and leg strength, and average resting and low back pain severity score (from an 11-point numerical pain rating scale; NRSpain) were collected at baseline and month 4. Results The TOTRX and LEXT improved lumbar extensor strength relative to CON and the TOTRX (P < .05). NRSpain scores at month 4 were lowest in the TOTRX group compared with the LEXT and CON groups, respectively (2.0 ± 1.7 points vs 3.7 ± 2.6 points and 4.6 ± 2.4 points; P < .006). A total of 53% and 67% of participants in the TOTRX and LEXT groups were responders who made lumbar extensor strength gains that achieved ≥20% greater than baseline values. Although the TOTRX demonstrated the greatest improvement in walking endurance among the intervention groups, this did not reach significance (10.1 ± 12.2% improvement in TOTRX vs 7.4 ± 30.0% LEXT and −1.7 ± 17.4% CON; P = .11). Gait speed increased most in the TOTRX (9.0 ± 13.5%) compared with the LEXT and CON groups (P < .05). The change in lumbar extensor strength explained 10.6% of the variance of the regression model for the change in walking endurance (P = .024). Conclusions The use of LEXT and TOTRX produced similar modest improvements in patients’ walking endurance. Lumbar extensor strength gain compared with leg strength gain is a moderate but important contributor to walking endurance in obese older adults with chronic low back pain. Responders to resistance exercise programs (event those with only lumbar extension exercise) who make at least a 20% improvement in strength can expect better improvement in walking endurance than those who do not achieve this strength improvement.

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IntroductionObesity rates continue to rise and more total hip arthroplasty procedures are being performed in progressively younger, obese patients. Hence, maintenance of long term physical function will become very important for quality of life, functional independence and hip prosthesis survival. Presently, there are no reviews of the long term efficacy of total hip arthroplasty on physical function. This review: 1) synopsized available data regarding obesity effects on long term functional outcomes after total hip arthroplasty, and 2) suggested future directions for research.MethodsA literature search was conducted from 1965 to January of 2011 for studies that evaluated long term functional outcomes at one year or longer after THA in obese (body mass index values ≥30 kg/m2) and non-obese patients (body mass index <30 kg/m2).ResultsFive retrospective studies and 18 prospective studies were identified as those that assessed physical function before surgery out to ≥ one year after total hip arthroplasty. Study sample sizes ranged from 108–18,968 and followed patients from one to twenty years. Total hip arthroplasty confers significant pain reduction and improvement in quality of life irrespective of body mass index. Functional improvement occurred after total hip arthroplasty among all studies, but obese patients generally did not attain the same level of physical function by the follow-up time point.DiscussionUncontrolled obesity after total hip arthroplasty is related to worsening of comorbidities and excessive health care costs over the long term. Aggressive and sustainable rehabilitation strategies that include physical exercise, psychosocial components and behavior modification may be highly useful in maximizing and maintaining weight loss after total hip arthroplasty.

Objective This study determined whether mobility and functional pain were different among older men and women with chronic low back pain (LBP) and varying body mass index (BMI) levels. Design This was a comparative, descriptive study of obese, older adults with LBP (N=55; 60-85 years). Participants were stratified based on BMI: overweight (25-29.9 kg/m2), obese (30-34.9 kg/m2) and severely obese (35 kg/m2). Participants completed a functional test battery (walking endurance, chair rise, stair climb, 7-day activity monitoring, gait parameters) and pain ratings with activity (‘functional pain’). Results Functional pain scores during walking and stair climb were highest in the severely obese group compared with the overweight group (p<0.05), but functional test scores were not found to be significantly different by BMI. Gait base of support was 36% greater and single/double support times were 3.1-6.1% greater in the severely obese group compared to the overweight group (p<0.05). Women had slower chair rise and stair climb times, and had slower walking velocity than men. Daily step numbers were lowest in the severely obese group compared with the obese and overweight groups (2971 vs 3511 and 4421 steps/day; p<0.05), but were not different by gender. Normalized lumbar extensor, abdominal curl and leg press strength values were lowest in the severely obese group, and women had 18-34% lower strength values than men for all three exercises (p<0.05). Lumbar strength was associated with stair climb, chair rise and walking endurance times. BMI was an independent predictor of walking endurance time, but not steps taken per day. Conclusions In this study, obese persons reported higher functional pain values during walking and stair climb compared to overweight participants, and had lower lumbar strength. Rehabilitation strategies that include lumbar extensor strengthening may help improve functional mobility and walking duration, both of which can help with weight management in the obese, older adult with chronic LBP.