Can exercise prevent the development of osteoarthritis, a deterioration of cartilage in the joints that affects more than 16-million Americans?
Or can exercise at least help to slow the progression of this common disease that can affect all ages but becomes more prevalent in older people?
Should exercise be an integral part of treatment for people with osteoarthritis? Does exercise truly provide relief?
Believe it or not, there are no definitive answers to these questions. But the Clearwater-based Arthritis Research Institute of America is now seeking participants for a new study to produce some answers.
This study is an offshoot of the institute's ongoing Clearwater Study, which is following 5,000 people over a 25-year period to determine who gets arthritis and why.
Heading the new three-year study is Dr. Aaron Sivan, an exercise physiologist who comes from the Department of Physiology at Hebrew University in Jerusalem, where he was doing research on osteoporosis.
In the early 1900s, he said, it was believed that physical activity caused osteoarthritis. Now the belief is that such activity is beneficial, perhaps even preventive, except in cases of professional athletes who develop the disease because of extreme wear and tear on their joints.
An article in the institute newsletter last spring announcing plans for the exercise study said, "Physicians and scientists have long believed that persons who are athletically active tolerate the disease far better and with less symptoms than those who are not physically active. Yet there is no sound scientific research to support the belief."
That's the reason for this study. The institute began running an ad in the Times several weeks ago seeking men and women at least 40 years old who suffer from pain in their hands and/or knees and either think or know they have osteoarthritis. There is no cost to the participants.
Volunteers have their hands and knees X-rayed to determine if they have at least grade two osteoarthritis. They undergo a battery of hand and leg strength tests and are asked to walk for about six minutes. They need to be able to exercise and have their doctor's permission to participate.
Betty Jean Hall, the institute's executive director, said 80 people had been screened as of Friday. Ninety percent of them were acceptable for the study, but 300 are needed.
Sivan said the participants will be divided at random into three groups for the initial six-month study. The first group will do nothing and be seen only once or twice. The second group will get together several times a week for social and educational activities. This is because some clinical studies indicate that just showing attention to someone can produce beneficial results.
The third group will meet three times a week for an hour of exercise, using equipment at the institute, which is on Duncan Avenue north of Gulf-to-Bay Boulevard.
Sivan wants to see if exercise can increase the range of motion and the strength of hands and knees and if it will reduce the intensity of pain. If so, those in the first two groups will begin exercising after the six months.
Assuming early findings are positive, the study will be expanded to other joints and to whether exercise can prevent arthritis.
Sivan said those he has seen so far are excited and ready to begin.
Hall also is excited about the exercise study as well as the much more extensive Clearwater Study, which over a 25-year period hopes to determine who is likely to get osteoarthritis, what risk factors are evident and what people can do to prevent or delay its onset.
Clearwater Study participants are called in once every two years for a physical exam and X-rays of the spine, knees, feet and hands. They also fill out questionnaires. Hall said 7,000 volunteers have been seen, but the number of active participants is now down to 4,000 because of people dying or moving away.
More volunteers are needed to get up to 5,000. The institute needs people from age 35 to 60, including both those who have arthritis and those who do not. My wife and I are in the latter group. We feel like we're helping to make medical history.
The non-profit institute also needs volunteers who aren't the subjects of the studies but who assist in them. Some 30 people already help out. They're the ones who really get excited. Many people don't, Hall said, because they can't relate to a 25-year study in a society that demands immediate satisfaction.
"Hey, have you cured arthritis yet?" some people love to ask her.
The answers being sought in the Clearwater Study can't come soon enough for Hall, either. She points to the extreme pain many people suffer, the millions of dollars spent on medication and the fact that the number of victims increase as Americans live longer.
Hall, who just marked her fourth anniversary with the institute, said osteoarthritis doesn't kill people like AIDS, which is another reason for the lack of excitement. "But it's a form of death when you can't walk across the room or brush your teeth," she said.