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Prise en charge de l’arthrose des membres inférieurs : l’exercice physique et la perte de poids sont-ils efficaces chez le sujet très âgé ?

Management of lower limb osteoarthritis: Are physical exercises and weight reduction efficient in very old patients?

  • Article Original / Original Article
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Les cahiers de l'année gérontologique

Résumé

Introduction

Les recommandations sur la prise en charge de la gonarthrose et de la coxarthrose insistent sur l’utilité des mesures non pharmacologiques, mais ne sont pas graduées selon l’âge et l’état du patient. Nous présentons une revue extensive des études concernant l’exercice physique et la perte de poids dans la coxarthrose et la gonarthrose du sujet âgé.

Méthodes

Recherche sur les bases de données Medline, Embase, Pascal, étude systématique des revues Cochrane, des recommandations et méta-analyses.

Résultats

Nous avons retrouvé au total 83 essais : seuls deux concernaient des sujets d’âge moyen supérieur ou égal à 75 ans ; nous avons donc abaissé la moyenne d’âge à 70 ans et trouvé 15 essais. Exercices à sec (huit essais) : leur efficacité sur la douleur et la fonction est démontrée par quatre essais avec groupe témoin. Les essais avec suivi à distance ne retrouvent pas de rémanence, sauf en cas d’autorééducation. Exercices aquatiques (cinq essais) ; leur efficacité est similaire à celle des exercices à sec, les deux étant supérieurs à l’absence de prise en charge. Perte de poids (deux essais) ; seuls les patients bénéficiant de la double prise en charge (régime + exercices) ont vu leurs douleurs significativement diminuer et leur fonction significativement augmenter.

Conclusion

Les recommandations sur l’exercice physique dans l’arthrose des membres inférieurs sont applicables aux sujets âgés de 70 à 80 ans. Leur efficacité à long terme nécessite une stratégie d’entretien. Des essais consacrés aux sujets très âgés et/ou polypathologiques sont nécessaires.

Abstract

Background

Scholarly recommendations for the management of hip and knee osteoarthritis, which emphasize the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.

Methods

Electronic search in Medline, Embase, and Pascal databases; systematic search of the Cochrane Reviews; manual search in guidelines and meta-analyses.

Results

We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials. Land-based exercise (8 trials) was effective on pain and function (4 controlled trials), with a persistent effect only in case of selfrehabilitation. Aquatic exercise (5 trials) was as effective as land-based exercise. Weight loss (2 trials): only patients under diet along with exercise had significant improvement on symptoms.

Conclusion

International recommendations on exercise for hip and knee osteoarthritis also apply to subjects aged 70–80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory.

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Authors and Affiliations

  1. Service de médecine gériatrique 3, hôpital Sainte-Périne (AP–HP), F-75016, Paris, France

    J. -L. Le Quintrec

  2. Service de rhumatologie, cabinet médical, hôpital Saint-Antoine (AP–HP), F-75012, Paris, France

    E. Maheu

  3. Pôle vieillissement, réadaptation et accompagnement, hôpital Paul-Brousse (AP–HP), F-94800, Villejuif, France

    B. Verlhac

  4. Cabinet médical, F-75020, Paris, France

    C. Cadet

  5. Service de rhumatologie, groupe hospitalier Paris–Saint-Joseph, F-75014, Paris, France

    P. Bréville

  6. Centre hospitalier, F-72000, Le Mans, France

    J. -M. Vetel

  7. Centre de médecine interne gériatrique, CHR–hôpital Porte-Madeleine, F-45000, Orléansn, France

    J. -B. Gauvain

  8. Service de médecine interne et gériatrie, F-34000, Montpellier, France

    C. Jeandel

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  1. J. -L. Le Quintrec
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  2. E. Maheu
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  4. C. Cadet
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Correspondence to J. -L. Le Quintrec.

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Le Quintrec, J.L., Maheu, E., Verlhac, B. et al. Prise en charge de l’arthrose des membres inférieurs : l’exercice physique et la perte de poids sont-ils efficaces chez le sujet très âgé ?. cah. année gerontol. 7, 66–73 (2015). https://doi.org/10.1007/s12612-015-0449-3

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