PDF herunterladen
Aktuelle Rheumatologie 2012; 37(03): 168-173
DOI: 10.1055/s-0032-1304595
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Sport bei (trotz) Arthrose

Sports and (in spite of) Osteoarthritis
T. Horstmann
1   MEDICAL PARK Bad Wiessee GmbH u. Co., St. Hubertus, Bad Wiessee
4   Technische Universität München, Fakultät für Sport und Gesundheitswissenschaften, Extraordinariat Konservative und rehabilitative Orthopädie, München
,
J. Böer
2   Medizinische Klinik und Polyklinik, Abteilung Sportmedizin, Tübingen
,
G. Haupt
2   Medizinische Klinik und Polyklinik, Abteilung Sportmedizin, Tübingen
,
J. Merk
3   Berufsgenossenschaftliche Unfallklink Tübingen, n/a, Tübingen
,
T. Brauner
4   Technische Universität München, Fakultät für Sport und Gesundheitswissenschaften, Extraordinariat Konservative und rehabilitative Orthopädie, München
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
21. Juni 2012 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Der Anteil von Patienten mit symptomatischer Arthrose wird aufgrund steigender Lebenserwartung und der älter werdenden Bevölkerung immer größer, vor dem Hintergrund knapper werdender Ressourcen im Gesundheitssystem wird die Etablierung kostengünstiger Trainingsmaßnahmen zur Therapie gefordert. Patienten mit Hüft- und Kniegelenksarthrose weisen sowohl prä- als auch postoperativ große Defizite in den Bereichen Kraft, Ausdauer und Koordination als auch kardiopulmonal auf. Sie befinden sich in einem Teufelskreislauf der über Einschränkung der Gelenkbeweglichkeit, Abnahme der Muskelkraft in Inaktivität und Gewichtszunahme mündet und damit mit höherer Gelenkbelastung dem Schmerz und Krankheitsprozess weiter Vorschub leistet. Es liegt deshalb nahe, neben der postoperativ durchgeführten Rehabilitation ein langfristig ausgerichtetes Trainingskonzept in den Lebensalltag der Arthrosepatienten zu integrieren. In zahlreichen Studien um das Hüft- und Kniesportkonzept konnten Verbesserungen und gute Trainierbarkeit von Kraftausdauer, Gelenkbeweglichkeit und gesundheitsbezogener Lebensqualität nachgewiesen werden. Das Konzept der Hüft- und Kniesportgruppen integriert soziale, pädagogische und motorisch- funktionale Aspekte und bietet Patienten eine ideale Unterstützung, um aktiv zu werden und über Jahre hinweg aktiv zu bleiben. Eine flächendeckende Etablierung dieses kostengünstigen, zielgerichteten Trainings in Gruppen zur sekundären Prävention der Arthrose, ähnlich dem Herzsportgruppenkonzept, wäre wünschenswert. Für Patienten sollte dann mit der Diagnose einer Arthrose nicht das Leid, sondern das Training beginnen.

Abstract

The proportion of patients with symptomatic arthrosis is increasing due to the higher life expectancy and aging population – hence, against the background of smaller financial resources in health systems the demand for cost-effective therapy emerges. Patients suffering from hip or knee joint arthrosis show pre- and post-operatively considerable deficits in strength, endurance, and coordination as well as in their cardiopulmonary capacities. They are in a vicious circle which results in decreasing joint mobility, reduced muscle strength, and further weight gain which, in turn, increases the stress on the joint and thereby fosters the progress of the disease even more. Thus, complementary to postoperative rehabilitation, a long-term exercise plan should be implemented in the patients’ everyday routine. This is because various studies investigating a hip and knee exercise concept were able to unveil positive effects in strength endurance, joint mobility, and health related quality of life. The concept of hip and knee exercise groups integrates social, pedagogical, and motor-functional aspects and offers a great opportunity for patients to start being active and to stay active on a long-term basis. It is desirable to establish these cost-effective and target-oriented exercise groups as part of the secondary prevention of arthrosis across the whole nation, similar to coronary sport groups.

Schlüsselwörter

Arthrose - Training - Sekundärprävention - Sport - Hüftsportgruppen

Key words

arthrosis - exercise - secondary prevention - sport - hip exercise groups
 

  • Literatur

  • 1 Lange AK, Vanwanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Rheum 2008; 59: 1488-1494
    CrossrefPubMedGoogle Scholar
  • 2 Lopez AD. Global burden of disease and risk factors. New York, NY, Washington, DC: Oxford University Press; World Bank; 2006
    CrossrefGoogle Scholar
  • 3 Statistisches Bundesamt . Gesundheit – Ausgaben, Krankheitskosten und Personal 2004. Wiesbaden: 2006
    Google Scholar
  • 4 Rabenda V, Manette C, Lemmens R et al. Direct and indirect costs attributable to osteoarthritis in active subjects. J Rheumatol 2006; 33: 1152-1158
    PubMedGoogle Scholar
  • 5 Küsswetter W. Endoprothetik und körperliche Belastung. Dtsch Z Sportmed 1998; 49: 294-251
    PubMedGoogle Scholar
  • 6 Sevick MA, Bradham DD, Muender M et al. Cost-effectiveness of aerobic and resistance exercise in seniors with knee osteoarthritis. Med Sci Sports Exerc 2000; 32: 1534-1540
    PubMedGoogle Scholar
  • 7 Horstmann T. Sportfähigkeit bei Arthrose und nach endoprothetischer Versorgung. Sportorthop – Sportverl 2000; 2000; 16: 26-29
    PubMedGoogle Scholar
  • 8 Vad V, Hong HM, Zazzali M et al. Exercise recommendations in athletes with early osteoarthritis of the knee. Sports Med 2002; 32: 729-739
    CrossrefPubMedGoogle Scholar
  • 9 van Dijk GM, Dekker J, Veenhof C et al. Course of functional status and pain in osteoarthritis of the hip or knee: a systematic review of the literature. Arthritis Rheum 2006; 55: 779-785
    CrossrefPubMedGoogle Scholar
  • 10 Schäfer M, Dreinhöfer K. Sport und Arthrose. Z Rheumatol 2009; 68: 804-810
    CrossrefPubMedGoogle Scholar
  • 11 Cochrane T, Davey RC, Matthes Edwards SM. Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis. Health Technol Assess 2005; 9 iii-iv, ix-xi, 1-114
    PubMedGoogle Scholar
  • 12 Veenhof C, Koke AJ, Dekker J et al. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial. Arthritis Rheum 2006; 55: 925-934
    CrossrefPubMedGoogle Scholar
  • 13 Crowninshield RD, Rosenberg AG, Sporer SM. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 2006; 443: 266-272
    Google Scholar
  • 14 Gilbey HJ, Ackland TR, Wang AW et al. Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res 2003; 193-200
    PubMedGoogle Scholar
  • 15 Horstmann T, Roecker K, Vornholt S et al. Konditionelle Defizite bei Coxarthrose und Hüftendoprothesen- Patienten. Dtsch Z Sportmed 2002; 53: 17-21
    PubMedGoogle Scholar
  • 16 Philbin EF, Groff GD, Ries MD et al. Cardiovascular fitness and health in patients with end-stage osteoarthritis. Arthritis Rheum 1995; 38: 799-805
    CrossrefPubMedGoogle Scholar
  • 17 Ries MD, Philbin EF, Groff GD. Relationship between severity of gonarthrosis and cardiovascular fitness. Clin Orthop Relat Res 1995; 169-176
    PubMedGoogle Scholar
  • 18 Sliwinski M, Sisto S. Gait quality of life, and their association following total hip arthroplasty. J Geriatr Phys Ther 2006; 29: 10-17
    PubMedGoogle Scholar
  • 19 Horstmann T, Heitkamp HC, Haupt G et al. Möglichkeiten und Grenzen der Sporttherapie bei Coxarthrose und Hüftendoprothesen – Patienten. Dtsch Z Sportmed 2001; 52: 274-278
    PubMedGoogle Scholar
  • 20 Bergmann G, Graichen F, Rohlmann A. Hip joint contact forces during stumbling. Langenbecks Arch Surg 2004; 389: 53-59
    CrossrefPubMedGoogle Scholar
  • 21 Freiwald J, Engelhardt M. Aspekte der Trainings- und Bewegungslehre: neuromuskuläre Dysbalancen. Gesundheitssport und Sporttherapie 1999; 15: 5-12
    PubMedGoogle Scholar
  • 22 Heitkamp HC, Horstmann T, Mayer F et al. Gain in strength and muscular balance after balance training. Int J Sports Med 2001; 22: 285-290
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 23 Mayer F, Gollhofer A, Berg A. Krafttraining mit Älteren und chronisch Kranken. Dtsch Z Sportmed 2003; 54: 88-94
    PubMedGoogle Scholar
  • 24 Baker KR, Nelson ME, Felson DT et al. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol 2001; 28: 1655-1665
    PubMedGoogle Scholar
  • 25 Fiatarone MA, Marks EC, Ryan ND et al. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA 13 1990; 263: 3029-3034
    CrossrefPubMedGoogle Scholar
  • 26 Fone S, Lundgren-Lindquist B. Health status and functional capacity in a group of successfully ageing 65–85-year-olds. Disabil Rehabil 2003; 25: 1044-1051
    CrossrefPubMedGoogle Scholar
  • 27 Almeida OP, Norman P, Hankey G et al. Successful mental health aging: results from a longitudinal study of older Australian men. Am J Geriatr Psychiatry 2006; 14: 27-35
    CrossrefPubMedGoogle Scholar
  • 28 Jan M, Tang P, Lin J et al. Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis. J Orthop Sports Phys Ther 2008; 38: 19-25
    PubMedGoogle Scholar
  • 29 Sekir U, Gür H. A multi-station proprioceptive exercise program in patients with bilateral knee osteoarthrosis: Functional capacity, pain and sensorimotor function. A randomized controlled trial. J Sports Sci Med 2005; 4: 590-603
    PubMedGoogle Scholar
  • 30 Ettinger WH, Burns R, Messier SP et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997; 277: 25-31
    CrossrefPubMedGoogle Scholar
  • 31 Fransen M, McConnell S, Bell M. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J Rheumatol Aug 2002; 29: 1737-1745
    PubMedGoogle Scholar
  • 32 Horstmann T, Jörger G, Heitkamp HC et al. Auswirkungen von Hüftsport auf Gangbild, Kraftverhalten und Lebensqualität von Koxarthrotikern. Akt Reumatol 2001; 26: 162-168
    PubMedGoogle Scholar
  • 33 Maurer BT, Stern AG, Kinossian B et al. Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Arch Phys Med Rehabil 1999; 80: 1293-1299
    CrossrefPubMedGoogle Scholar
  • 34 Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport 2011; 14: 4-9
    CrossrefPubMedGoogle Scholar
  • 35 Fransen M, McConnell S, Hernandez-Molina G et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev 2009; CD007912
    PubMedGoogle Scholar
  • 36 Wang AW, Gilbey HJ, Ackland TR. Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty: a randomized, controlled trial. Am J Phys Med Rehabil Nov 2002; 81: 801-806
    CrossrefPubMedGoogle Scholar
  • 37 Suetta C, Magnusson SP, Rosted A et al. Resistance training in the early postoperative phase reduces hospitalization and leads to muscle hypertrophy in elderly hip surgery patients – a controlled, randomized study. J Am Geriatr Soc Dec 2004; 52: 2016-2022
    CrossrefPubMedGoogle Scholar
  • 38 Haupt G, Horstmann T. Hüftschule: Das Erfolgsprogramm für Jung und Alt; [die besten Übungen für Ihr Hüftgelenk]. 3rd ed. Schorndorf: Hofmann; 2009
    Google Scholar
  • 39 Merk J, Horstmann T. Knie aktiv: 100 Übungen bei Arthrose und nach Gelenkersatz, Verletzungen, Operationen. 3. Aufl. Stuttgart: Hirzel; 2008
    Google Scholar
  • 40 Roddy E, Zhang W, Doherty M et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee – the MOVE consensus. Rheumatology 2005; 44: 67-73
    CrossrefPubMedGoogle Scholar
  • 41 Mont MA, LaPorte DM, Mullick T et al. Tennis after total hip arthroplasty. Am J Sports Med Jan-Feb 1999; 27: 60-64
    CrossrefPubMedGoogle Scholar
  • 42 Huch K, Muller KA, Sturmer T et al. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study. Ann Rheum Dis Dec 2005; 64: 1715-1720
    CrossrefPubMedGoogle Scholar
  • 43 Vignon E, Valat JP, Rossignol M et al. Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint Bone Spine 2006; 73: 442-455
    CrossrefPubMedGoogle Scholar
  • 44 Buszewicz M, Rait G, Griffin M et al. Self management of arthritis in primary care: randomised controlled trial. BMJ 2006; 333-879
    PubMedGoogle Scholar
  • 45 Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med May-Jun 2001; 29: 377-388
    CrossrefPubMedGoogle Scholar
  • 46 Kuster MS. Exercise recommendations after total joint replacement: a review of the current literature and proposal of scientifically based guidelines. Sports Med 2002; 32: 433-445
    CrossrefPubMedGoogle Scholar
  • 47 Jan M, Lin J, Liau J et al. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther 2008; 88: 427-436
    CrossrefPubMedGoogle Scholar
  • 48 Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Phys Ther Jan 2007; 87: 32-43
    CrossrefPubMedGoogle Scholar
  • 49 Zhang W, Nuki G, Moskowitz RW et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 2010; 18: 476-499
    CrossrefPubMedGoogle Scholar