Die Bedeutung von Sport in der Entstehung, Prävention und Rehabilitation der Arthrose

Zusammenfassung

Degenerative Gelenkerkrankungen stehen im öffentlichen und medizinischen Interesse und sind zudem wirtschaftlich bedeutsam. Dennoch sind wesentliche Zusammenhänge wie der Einfluss sportlicher Aktivitäten derzeit nicht abschließend geklärt. Ein Grund hierfür liegt in der multifaktoriellen Genese und in unterschiedlichen Behandlungs- und Präventionskonzepten.

Grundsätzlich wird in Sportarten mit hohem Anteil an Rotations- und Scherkraftbeanspruchungen bei gleichzeitig hochintensiver Belastung von einem gering erhöhten Arthroserisiko ausgegangen. Allerdings resultiert eine Arthrose dabei häufig aus Verletzungen. Dagegen scheinen moderate sportliche Belastungen nicht mit einem erhöhten Arthroserisiko einherzugehen. Die Beurteilung hat dementsprechend auf der Basis der Sportart, der Trainingsintensität, von Vorverletzungen und Vorschäden, der Körperkomposition und einer möglichen additiven beruflichen Belastung zu erfolgen. Aus Sicht der Prävention und Rehabilitation von degenerativen Gelenkerkrankungen hat der Sport dagegen eine gesteigerte Bedeutung. Einerseits kann körperliche Aktivität degenerativen Gelenkerkrankungen vorbeugen, andererseits konnte durch einen gezielten Einsatz sportlicher Belastungen eine positive Wirkung in der Behandlung von Arthrosen belegt werden.

Abstract

Degenerative joint diseases are a matter of public and medical interest and are also of economic importance. Nevertheless, essential relationships, like the influence of athletic activities, have not yet been clarified. Reasons are the multifactorial genesis and various treatment and prevention concepts. Basically, a slightly elevated risk of OA is assumed in high-intensity sports with a high proportion of rotational and shear forces, which is, however, closely tied to possible injuries. By contrast, moderate athletic activity does not appear to be associated with an elevated OA risk. The assessment must be made on the basis of the kind of sports activities, training intensity, prior injuries and overuse, body composition, and possible additive occupational stress. Sports activities are important for prevention of OA and for rehabilitation. On the one hand, physical activity can prevent degenerative joint diseases, on the other hand, differentiated application has been confirmed to be beneficial in the treatment of OA.

Literatur

• 1 ACSM Position Stand Paper . Exercise and physical activity for older adults.  Med Sci Sports Exerc. 1998;  30 992-1008
• 2 ACSM Position Stand Paper . The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults.  Med Sci Sports Exerc. 1998;  30 975-991
• 3 American College of Rheumatology Subcommittee on Osteoarthritis Guidelines . Recommendations for the medical management of osteoarthritis of the hip and knee.  Arthritis Rheum. 2000;  38 1505-1515
• 4 Andersson S, Nilsson B, Hessel T. et al . Degenerative joint disease in ballet dancers.  Clin Orthop. 1989;  238 233-236
• 5 Axmacher B, Lindberg H. Coxarthrosis in farmers.  Clin Orthop. 1993;  287 82-86
• 6 Bollen S R, Wright O, Wright V. Radiographic changes in the hand of rock climbers.  Br J Sports Med. 1994;  28 185-186
• 7 Brandt K D. Putting muscle into osteoarthritis.  Ann Intern Med. 1997;  127 154-155
• 8 Buckwalter J A, Lane L E. Athletics and osteoarthritis.  Am J Sports Med. 1997;  25 873-881
• 9 Coggon D, Kellingray S, Inskip H. et al . Osteoarthritis of the hip and occupational lifting.  Am J Epidemiol. 1998;  147 523-528
• 10 Conaghan P G. Update on osteoarthritis part 1: current concepts and the relation to exercise.  Br J Sports Med. 2002;  36 330-333
• 11 Deacon A, Bennell K, Kiss Z S. et al . Osteoarthritis of the knee in retired, elite Australian Rules footballers.  Med J Aust. 1997;  166 187-190
• 12 DGSP, Sektion Rehabilitation und Behindertensport. Arthrose und Sport. www.dgsp.de. 
• 13 Dijk C N van, Lim L S, Poortman A. et al . Degenerative joint disease in female ballet dancers.  Am J Sports Med. 1995;  23 295-300
• 14 Doherty M, Watt I I, Dieppe P. Influence of primary generalised osteoarthritis on development of secondary arthritis.  Lancet. 1983;  2 8-11
• 15 Ettinger W H, Afable R F. Physical disability from knee osteoarthritis: the role of exercise as an intervention.  Med Sci Sports Exerc. 1994;  26 1435-1440
• 16 Ettinger W H, Burns R, Messier S P. et al . A randomized trial comparing aerobic exercise and resistance exercise with a health educational program in older adults with knee osteoarthritis: The fitness arthritis and senior trials (FAST).  JAMA. 1997;  277 25-31
• 17 Felson D T, Lawrence R C, Dieppe P A. et al . Osteoarthritis: New Insights. Part 1: The disease and its risk factors.  Ann Intern Med. 2000;  133 635-646
• 18 Felson D T, Lawrence R C, Hochberg M C. et al . Osteoarthritis: New Insights. Part 2: Treatment approaches.  Ann Intern Med. 2000;  133 726-737
• 19 Felson D T, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention.  Arthritis Rheum. 1998;  41 1343-1355
• 20 Fitzgerald B, McLatchie G R. Degenerative joint disease in weight lifters. Fact or fiction?.  Br J Sports Med. 1980;  14 97-101
• 21 Fries J F, Singh G, Morfeld D. et al . Running and the development of disability with age.  Ann Intern Med. 1994;  121 502-509
• 22 Goldberg S H, von Feldt J M, Lonner J H. Pharmacologic therapy for osteoarthritis.  Am J Orthop. 2002;  12 673-680
• 23 Gross P, Marti B. Risk of degenerative ankle joint disease in volleyball players: study of former elite athletes.  Int J Sports Med. 1999;  20 58-63
• 24 Gross P, Marti B. Sports activity and risk of arthrosis.  Schweiz Med Wochenschr. 1997;  127 967-977
• 25 Guccione A A, Felson D T, Anderson J J. Defining arthritis and measuring functional status in elders: methodological issues in the study of disease and physical disability.  Am J Public Health. 1990;  80 945-949
• 26 Hame S L, Melone C P. Boxer’s knuckle. Traumatic disruption of the extensor hood.  Hand Clin. 2000;  16 375-380
• 27 Horas U, Pelinkovic D, Herr G. et al . Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint.  J Bone Joint Surg. 2003;  85-A 185-192
• 28 Karlsson J, Sjögren L S, Lohmander L S. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study.  Rheumatology. 2002;  41 1240-1248
• 29 Kettunen J A, Kujala U M, Kaprio J. et al . Lower limb function among former elite male athletes.  Am J Sports Med. 2001;  29 2-8
• 30 Kettunen J A, Kujala U M, Räty H. et al . Jumping height in former elite athletes.  Eur J Appl Physiol Occup Physiol. 1999;  79 197-201
• 31 Knobloch M, Marti B, Biedert R. et al . Zur Arthrosegefährdung des oberen Sprunggelenkes bei Langstreckenläufern: Kontrollierte Nachuntersuchung ehemaliger Eliteathleten.  Sportverletz Sportschaden. 1990;  4 175-179
• 32 Kohatsu N D, Schurman D J. Risk factors for the development of osteoarthritis of the knee.  Clin Orthop. 1990;  261 242-246
• 33 Konradsen L, Hansen E B, Sondergaard L. Long distance running and osteoarthritis.  Am J Sports Med. 1990;  18 379-381
• 34 Kovar P A, Allegrante J P, MacKenzie C R. et al . Supervised fitness walking in patients with osteoarthritis of the knee.  Ann Intern Med. 1992;  116 529-534
• 35 Kujala U M, Kaprio J, Sarna S. Osteoarthritis of the weight bearing joints of lower limbs in former elite male athletes.  BMJ. 1994;  308 231-234
• 36 Kujala U M, Kettunen J, Paananen H. et al . Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters.  Arthritis Rheum. 1995;  38 539-546
• 37 Lane N E, Michel B, Bjorkengren A. et al . The risk of osteoarthritis with running and aging. A 5-year longitudinal study.  J Rheumatol. 1993;  20 462-468
• 38 Lane N E. Exercise: a cause of osteoarthritis.  J Rheumatol. 1995;  22 3-6
• 39 Lane N E. Long-distance running, bone density and osteoarthritis.  JAMA. 1986;  255 1147-1151
• 40 Lane N E. Physical activity at leisure and risk of osteoarthritis.  Ann Rheum Dis. 1996;  55 682-684
• 41 Leach R E. Osteoarthritis - a sports medicine problem?.  Am J Sports Med. 1999;  27 1
• 42 Lievense A M, Bierma-Zeinstra S MA, Verhagen A P. et al . Influence of obesity on the development of osteoarthritis of the hip: a systematic review.  Rheumatology. 2002;  41 115-116
• 43 Lindberg H, Roos H, Gardsell P. Prevalence of coxarthrosis in former soccer players: 286 players compared with matched controls.  Acta Orthop Scand. 1993;  64 165-167
• 44 Manninen P, Riihimäki H, Heliövaara M. et al . Physical exercise and risk of severe knee osteoarthritis requiring arthroplasty.  Rheumatology. 2001;  40 432-437
• 45 Marti B, Knobloch M, Tschopp A. et al . Is excessive running predictive of degenerative hip disease? Controlled study of former elite athletes.  BMJ. 1989;  299 91-93
• 46 McAlindon T E, LaValley M P, Gulin J P. et al . Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis.  JAMA. 2000;  283 1469-1475
• 47 McAlindon T E, Wilson P W, Aliabadi P. et al . Level of physical activity and risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study.  Am J Med. 1999;  106 151-157
• 48 Messier S P. Osteoarthritis of the knee: an interdisciplinary perspective.  Med Sci Sports Exerc. 1994;  26 1427-1428
• 49 Minor M A, Hewitt J E, Webel R R. et al . Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis.  Arthritis Rheum. 1989;  32 1396-1405
• 50 Minor M A. Physical activity and management of osteoarthritis.  Ann Behav Med. 1990;  13 117-124
• 51 Newton P M, Mow V C, Gardner T R. et al . The effect of lifelong exercise on canine articular cartilage.  Am J Sports Med. 1997;  25 282-287
• 52 O’Reilly S C, Jones A, Muir K R. et al . Quadriceps weakness in knee osteoarthritis: the effect of pain and disability.  Ann Rheum Dis. 1998;  57 588-594
• 53 Panush R S, Brown D G. Exercise and arthritis.  Sports Med. 1987;  4 54-64
• 54 Panush R S, Schmidt C, Caldwell J. et al . Is running associated with degenerative joint disease?.  JAMA. 1986;  255 1152-1154
• 55 Pavelka K, Gatterova J, Olejarova M. et al . Glucosamine sulphate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study.  Arch Intern Med. 2002;  14 2113-2123
• 56 Peterson L, Brittberg M, Kiviranta I. et al . Autologous chondrocyte transplantation. Biomechanics and long-term durability.  Am J Sports Med. 2002;  30 2-12
• 57 Roos H, Lindberg H, Gardsell P. et al . The prevalence of gonarthrosis in former soccer players and its relation to meniscectomy.  Am J Sports Med. 1994;  22 219-222
• 58 Schmitt H, Brocai D RC, Carstens C. Long-term review of the lumbar spine in javelin throwers.  JBJS. 2001;  83-B 324-327
• 59 Schmitt H, Brocai D RC, Lukoschek M. High prevalence of hip arthrosis in former elite javelin throwers and high jumpers.  Acta Orthop Scand (im Druck).
• 60 Schmitt H, Hansmann H J, Brocai D RC. et al . Long term changes of the throwing arm in former elite javelin throwers.  Int J Sports Med. 2001;  22 275-279
• 61 Schmitt H, Lemke J M, Brocai D RC. et al . Degenerative changes in the ankle in former elite high jumpers.  Clin J Sports Med. 2003;  13 6-10
• 62 Sharma L, Pai Y C, Rymer W Z. Is knee joint proprioception worse in the arthritic knee versus the unaffected knee in unilateral knee osteoarthritis?.  Arthritis Rheum. 1997;  40 1518-1525
• 63 Shepard G J, Banks A J, Ryan W G. Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries.  Br J Sports Med. 2003;  37 80-81
• 64 Slemenda C, Brandt K D, Heilman. et al . Quadriceps weakness and osteoarthritis of the knee.  Ann Intern Med. 1997;  127 97-104
• 65 Slemenda C, Heilman D K, Brandt K D. et al . Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women.  Arthritis Rheum. 1998;  41 1951-1959
• 66 Sohn R S, Micheli L J. The effect of running on the pathogenesis of osteoarthritis of the hips and knees.  Clin Orthop. 1985;  198 106-109
• 67 Spector T D, Harris P A, Hart D I. et al . Risk of osteoarthritis associated with long-term weight-bearing sports.  Arthritis Rheum. 1996;  39 988-995
• 68 Stenlund B. Shoulder tendinitis and osteoarthrosis of the acromioclavicular joint and their relation to sports.  Br J Sports Med. 1993;  27 125-130
• 69 Suter E, Herzog W. Does muscle inhibition after knee injury increase the risk of osteoarthritis?.  Exerc Sport Sci Rev. 2000;  28 15-18
• 70 Sutton A J, Muir K R, Mockett S. et al . A case control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey.  Ann Rheum Dis. 2001;  60 756-764
• 71 Teitz C C, Kilcoyne R F. Premature osteoarthrosis in professional dancers.  Clin J Sports Med. 1998;  8 255-259
• 72 Towheed T E, Anastassiades T P, Shea B. et al .Glucosamine therapy for treating osteoarthritis (Cochrane Review). In: The Cochrane Library, Issue 3. Update Software Oxford; 2003
• 73 Vad V, Hong H M, Zazzali M. et al . Exercise recommendations in athletes with early osteoarthritis of the knee.  Sports Med. 2002;  32 729-739
• 74 van Baar M E, Assendelft W J, Dekker J. et al . Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials.  Arthritis Rheum. 1999;  42 1361-1369
• 75 Vingard E, Alfredsson L, Malchau H. Osteoarthrosis of the hip in women and its relationship to physical load from sports activities.  Am J Sports Med. 1998;  26 78-82
• 76 Vita A J, Terry R B, Hubert H B. et al . Aging, health risks, and cumulative disability.  N Engl J Med. 1998;  338 1035-1041
• 77 White J A, Wright V, Hudson A M. et al . Relationships between habitual physical activity and osteoarthritis in ageing women.  Public Health. 1993;  107 459-470