Age Related Issues in Sports Medicine

 

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Total Joint Replacements and Sport

There are approximately 500,000 total joint replacements performed each year around the world, and approximately 300,000 of those are total knee replacement performed in the United States. (Vagel, Carotenuto, & Levine, 2011). Typically, total joint replacements (TJR) are performed to relieve pain and restore the quality of life for the individual receiving the TJR. Many of these individuals receiving a TJR participated in sporting activities prior to surgery; currently it is unclear whether it is safe for these individuals to continue to participate in sports postoperatively. Carotenuto et al. (2011), found that the current research has conflicting evidence regarding participation in sports following a TJR. The concern that high impact sports will increase the need for revision due to joint loosening or wear of joint components leads many surgeons to list sporting activities as a precaution postoperatively.
According to Golant, Christoforou, Slover, and Zuckerman (2010), postoperative participation in sporting events is beneficial to the patients overall health. An active lifestyle increases an individual’s muscular strength, endurance, proprioception, cardiovascular health, balance, and coordination, decreasing the likelihood for injury and falls. Golant el al. (2010), found that patients with a TJR also benefit from physical activity, but the level of activity is controversial. Some studies promote the participation of high impact sports while others refute high impact sport participation due to the risk of revision.
Though high impact sports for patients following a TJR are controversial, most studies have found that low impact sports are recommended. Sports like walking, water aerobics, cycling, swimming, and cross-country skiing are healthy and recommended by most surgeons. Golant et al. (2010) noted that low impact sports have been found to decrease the risk for revision due to loosening when compared to more sedentary patients. Chatterji, Ashworth, Lewis, and Dobson (2004) found an increase in low impact sports participation with patients who received a total hip arthroplasty. Regardless of the level of impact a patient wishes to participate following a TJR, it is recommended the patient discusses the sport with their surgeon prior to surgery to allow the surgeon to determine the appropriate approach and type of implant to accommodate the forces imposed by the sport.

Recent Related Research (from Pubmed)

Older adults are the least physically active age group and account for the highest amount of medical cost (Nelson, Rejeski, Blair, Duncan, & Judge, 2007), which led to many studies to determine an appropriate level of exercise for adults to maintain a healthy lifestyle. The American College of Sports Medicine (ACSM, 2015) has established a guideline for a recommended level of activity for the healthy adult. The current recommendations are as follows:

Cardiorespiratory moderate intensity ≥ 30min a day 5 days a week
Vigorous exercise ≥ 20min a day 3 days a week

Resistance Exercise each major muscle group 2-3 days a week

Flexibility Exercise Maintain Joint Range of Motion 2 days a week

Neuromotor for balance, agility, & coordination 2-3 days a week
Exercise

Individuals who currently have a more sedentary lifestyle are encouraged to gradually increase the amount and level of activity to decrease the potential for overuse injury and to provide for a more enjoyable exercise experience. Nelson et al. (2007) recommends that older adults create a plan for physical activity. The plan should “reduce sedentary behavior”, “increase moderate levels of activity”, and “take a gradual step approach”(p. 1101). Research has shown physical activity to increase an individual’s overall health, decrease medical costs, and provide psychological benefits for all age groups, which has led to campaigns that encourage daily physical activity.

References

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