From Medscape Medical News
Fran Lowry
February 22, 2010 — A 30-minute walk taken at least 3 days a week combined with glucosamine sulfate supplements may reduce symptoms of mild to moderate hip or knee osteoarthritis (OA), researchers report in a new study published online February 12 in Arthritis Research & Therapy.
"Management of [OA] includes the use of non-pharmacologic and pharmacologic therapies," write Norman T. M. Ng, MD, from the University of Queensland, Brisbane, Australia, and colleagues. "Although walking is commonly recommended for reducing pain and increasing physical function in people with OA, glucosamine sulphate has also been used to alleviate pain and slow the progression of OA."
The main goal of this feasibility study was to evaluate the combined effects of a progressive walking program and glucosamine sulfate intake on OA symptoms and physical activity participation in people with mild to moderate OA.
In addition, the investigators compared the effectiveness of 2 frequencies of walking (3 vs 5 days per week) and 3 step levels (1500, 3000, and 6000 steps per day), combined with glucosamine sulfate supplements, and also examined compliance with supplement intake and the walking program.
The study included 28 patients aged 42 to 73 years. All patients were given 1500 mg of glucosamine sulfate per day for 6 weeks and then began a 12-week progressive walking program while continuing to take glucosamine.
Fifteen patients were randomly assigned to walk 5 days per week, and the remaining 13 were randomly assigned to walk 3 days per week. The participants received a pedometer to monitor their step counts. Step level of walking was gradually increased to 3000 steps per day during the first 6 weeks of walking and to 6000 steps per day for the next 6 weeks in both groups.
Patients were assessed at baseline and at 6-, 12-, 18-, and 24-week follow-ups.
Glucosamine Alone Was Helpful
The researchers found that during the first 6 weeks of the study, when patients were taking glucosamine supplements only, physical activity levels, physical function, and total Western Ontario and McMaster Universities scores improved (P < .05).
These outcomes continued to improve through to the final follow-up, although most improvements were seen between weeks 6 and 12, the authors report.
In addition, significant improvements were seen in patients' self-efficacy in managing arthritis pain and "other symptoms," in physical activity self-regulation, and in the number of perceived barriers to physical activity.
Compliance with the walking program was the same for both groups.
Walking 5 days per week was not more effective than walking 3 days per week in reducing pain and stiffness, increasing physical function, or improving most other measures used in the study, the authors report.
Participants in the 3-day walking group walked 3 days per week, but participants in the 5-day walking group walked slightly less than 4 days per week, which suggests that it may be difficult to get people with hip or knee OA to walk more than 3 to 4 days a week, the authors write.
Increased Activity Further Improved Results
Increasing the number of steps from 1500 to 3000 steps per day, combined with glucosamine intake, resulted in a 125% increase in minutes of physical activity, a 17% reduction in pain scores, and improvements in physical function. Increasing the steps to 6000 steps per day resulted in a further 57% increase in physical activity participation and further improvements in physical function.
The limitations of the study include the small sample size, the use of self-report data, the fact that joint space narrowing was not measured to assess the effectiveness of glucosamine supplementation, lack of a placebo control group, and lack of radiographic evidence to confirm the diagnosis and severity of OA.
"Although the study included a small sample, the findings provide preliminary evidence that OA sufferers can obtain health-related benefits from the combination of glucosamine supplements and walking," the authors conclude. "If the benefits of this program are confirmed, it could be promoted to increase physical activity among people with hip or knee OA."
Chris Morris, MD, a practicing rheumatologist at Arthritis Associates in Kingsport, Tennessee, commented on this study for Medscape Rheumatology, saying that it supports what many rheumatologists believe — that low- to no-impact exercise can make a difference in OA of the knee.
Glucosamine a Red Herring?
He questioned why glucosamine was added to the walking program, however. "I am perplexed as to why they included the glucosamine in the study. I think it is a bit of a red herring and is a flaw of the study, simply because they had no control group to see if exercise without glucosamine did as well. It is possible that they purposely did this to avoid questions related to glucosamine, using the use of the supplement as a way to standardize the patients," he said.
Dr. Morris added that many patients have unrealistic expectations about the beneficial effects of exercise.
"They expect immediacy in terms of results — they expect to be able to do everything they did 20 years (and often 50 pounds) earlier, and when their knees hurt, they just give up. Patients need to understand that they have to start out light and gradually work their way up — that any program takes time, and that they must commit to the activity long-term."
The study by the Australian researchers "provides yet another study to help support the viewpoint that exercise can help arthritic symptoms and the patient's well-being," Dr. Morris said. "I encourage my patients to exercise and have recommended walking to those who do not have the resources or access to health clubs, wellness centers, water exercise programs. Most people live reasonably near an enclosed shopping mall, many of which are carpeted, and most of which open their doors early for walkers."
Sanofi-aventis Consumer Health Care supplied the glucosamine supplements used in this study. Dr. Ng and Dr. Morris have disclosed no relevant financial interests.
Arthritis Res Therapy. Published online February 12, 2010.
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