This work evaluated activity levels in a group of healthy older adults to establish a target activity level for adults of similar age after total joint arthroplasty (TJA). With the decreasing age of TJA patients, it is essential to have a reference for activity level in younger patients as activity level affects quality of life and implant design. 54 asymptomatic, healthy older adults with no clinical evidence of lower extremity OA participated. The main outcome measure, average daily step count, was measured using an accelerometer-based activity monitor. On average the group took 8 8 1 3 ± 3 6 1 1 steps per day, approximately 4000 more steps per day than has been previously reported in patients following total joint arthroplasty. The present work provides a reference for activity after joint arthroplasty which is relevant given the projected number of people under the age of 65 who will undergo joint arthroplasty in the coming years. 1. Introduction It is well accepted that levels of physical activity in older adults relate to physical and cognitive performance measures. Physical activity is promoted as beneficial for a variety of diseases affecting middle-aged and older adults. Activity levels, specifically locomotor activities, are also relevant to total joint arthroplasty (TJA) surgery, both for the design of implants and for rehabilitation programs where postsurgical activity level is considered to be an important clinical outcome measure. In addition, differences in activity levels have been shown to affect the rate of polyethylene wear [1], a critical factor in implant longevity. Specifically, walking cycles have been reported to influence wear rates of polyethylene implants [2, 3]. Activity levels in patients after total hip and knee arthroplasty have been studied extensively, and have been reported to average approximately 5,000 steps per day in these patients [4–6], with one report suggesting that younger patients may attain an average of 6000 steps per day [7]. In contrast, the currently recommended goal for daily physical activity in adults is 10,000 steps per day, or 30 minutes of brisk walking [8]. A meta-analysis examining step counts assessed by pedometer in adults found that activity levels are related to age with activity in adults 18–65 approaching the 10,000-step recommendation while in those over 65 the mean daily step count was approximately 6500 steps [9]. While much can be gained from this meta-analysis it does not provide information specifically concerning activity levels in healthy older adults who are free from clinical
References
[1]
T. P. Schmalzried, E. S. Szuszczewicz, M. R. Northfield et al., “Quantitative assessment of walking activity after total hip or knee replacement,” Journal of Bone and Joint Surgery A, vol. 80, no. 1, pp. 54–59, 1998.
[2]
B. B. Seedhom and N. C. Wallbridge, “Walking activities and wear of prostheses,” Annals of the Rheumatic Diseases, vol. 44, no. 12, pp. 838–843, 1985.
[3]
T. P. Schmalzried, E. F. Shepherd, F. J. Dorey et al., “The John Charnley Award. Wear is a function of use, not time,” Clinical Orthopaedics and Related Research, no. 381, pp. 36–46, 2000.
[4]
C. D. McClung, C. A. Zahiri, J. K. Higa, H. C. Amstutz, and T. P. Schmalzried, “Relationship between body mass index and activity in hip or knee arthroplasty patients,” Journal of Orthopaedic Research, vol. 18, pp. 35–39, 2000.
[5]
C. A. Zahiri, T. P. Schmalzried, E. S. Szuszczewicz, and H. C. Amstutz, “Assessing activity in joint replacement patients,” Journal of Arthroplasty, vol. 13, no. 8, pp. 890–895, 1998.
[6]
M. Silva, C. D. McClung, M. A. Dela Rosa, F. J. Dorey, and T. P. Schmalzried, “Activity sampling in the assessment of patients with total joint arthroplasty,” Journal of Arthroplasty, vol. 20, no. 4, pp. 487–491, 2005.
[7]
M. Morlock, E. Schneider, A. Bluhm et al., “Duration and frequency of every day activities in total hip patients,” Journal of Biomechanics, vol. 34, no. 7, pp. 873–881, 2001.
[8]
W. L. Haskell, I. M. Lee, R. R. Pate et al., “Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association,” Medicine and Science in Sports and Exercise, vol. 39, no. 8, pp. 1423–1434, 2007.
[9]
R. W. Bohannon, “Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis,” Physical Therapy, vol. 87, no. 12, pp. 1642–1650, 2007.
[10]
S. M. Kurtz, E. Lau, K. Ong, K. Zhao, M. Kelly, and K. J. Bozic, “Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030,” Clinical Orthopaedics and Related Research, vol. 467, no. 10, pp. 2606–2612, 2009.
[11]
P. L. Schneider, S. E. Crouter, and D. R. Bassett, “Pedometer measures of free-living physical activity: comparison of 13 models,” Medicine and Science in Sports and Exercise, vol. 36, no. 2, pp. 331–335, 2004.
[12]
S. McConnell, P. Kolopack, and A. M. Davis, “The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties,” Arthritis Care and Research, vol. 45, no. 5, pp. 453–461, 2001.
[13]
C. Tudor-Locke and D. R. Bassett Jr., “How many steps/day are enough? Preliminary pedometer indices for public health,” Sports Medicine, vol. 34, no. 1, pp. 1–8, 2004.
[14]
R. Wagenmakers, M. Stevens, W. Zijlstra et al., “Habitual physical activity behavior of patients after primary total hip arthroplasty,” Physical Therapy, vol. 88, no. 9, pp. 1039–1048, 2008.
[15]
Z. Cukras, K. Praczko, T. Kostka, and A. Jegier, “Physical activity of elderly patients after total hip arthroplasty,” Ortopedia Traumatologia Rehabilitacja, vol. 9, no. 3, pp. 286–296, 2007.
[16]
P. D. Franklin, W. Li, and D. C. Ayers, “The Chitranjan Ranawat award : functional outcome after total knee replacement varies with patient attributes,” Clinical Orthopaedics and Related Research, vol. 466, no. 11, pp. 2597–2604, 2008.
[17]
V. F. Sechriest, R. F. Kyle, D. J. Marek, J. D. Spates, K. J. Saleh, and M. Kuskowski, “ctivity level in young patients with primary total hip arthroplasty: a 5-year minimum follow-up,” Journal of Arthroplasty, vol. 22, no. 1, pp. 39–47, 2007.
[18]
J. N. Farr, S. B. Going, T. G. Lohman et al., “Physical activity levels in patients with early knee osteoarthritis measured by accelerometry,” Arthritis Care and Research, vol. 59, no. 9, pp. 1229–1236, 2008.
[19]
C. G. Ryan, P. M. Grant, W. W. Tigbe, and M. H. Granat, “The validity and reliability of a novel activity monitor as a measure of walking,” British Journal of Sports Medicine, vol. 40, no. 9, pp. 779–784, 2006.
[20]
M. Silva, E. F. Shepherd, W. O. Jackson, F. J. Dorey, and T. P. Schmalzried, “Average patient walking activity approaches 2 million cycles per year: pedometers under-record walking activity,” Journal of Arthroplasty, vol. 17, no. 6, pp. 693–697, 2002.
[21]
E. F. Shepherd, E. Toloza, C. D. McClung, and T. P. Schmalzried, “Step activity monitor: increased accuracy in quantifying ambulatory activity,” Journal of Orthopaedic Research, vol. 17, no. 5, pp. 703–708, 1999.
[22]
R. Powell, J. L. Allan, D. W. Johnston et al., “Activity and affect: repeated within-participant assessment in people after joint replacement surgery,” Rehabilitation Psychology, vol. 54, no. 1, pp. 83–90, 2009.
[23]
A. P. Marsh, R. M. Vance, T. L. Frederick, S. A. Hesselmann, and W. J. Rejeski, “Objective assessment of activity in older adults at risk for mobility disability,” Medicine and Science in Sports and Exercise, vol. 39, no. 6, pp. 1020–1026, 2007.
[24]
R. D. Crowninshield, A. G. Rosenberg, and S. M. Sporer, “Changing demographics of patients with total joint replacement,” Clinical Orthopaedics and Related Research, vol. 443, pp. 266–272, 2006.
[25]
A. K. Nilsdotter, S. Toksvig-Larsen, and E. M. Roos, “Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up,” Acta Orthopaedica, vol. 80, no. 1, pp. 55–61, 2009.
