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Author Spotlight: Investigating the Mechanism of Action of Acupotomy in Treating Knee Osteoarthritis
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Which matters more for preventing knee replacements: reducing overactivity or combating inactivity?

Masashi Kanai1,2, Upul Cooray3,4, Takahiro Miki1,5

  • 1Insight Lab, PREVENT Inc., Nagoya, Aichi, Japan.

Aging Clinical and Experimental Research
|March 11, 2026
PubMed
Summary

Optimizing daily physical activity (PA) can reduce knee replacement surgery risk in older adults with knee osteoarthritis (OA). Tailoring PA to optimal levels, rather than excessive activity, is most beneficial for knee OA management.

Keywords:
Knee osteoarthritisPhysical Activity Scale for the Elderlymachine learningmodified treatment policytotal knee arthroplasty

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Area of Science:

  • Gerontology
  • Orthopedics
  • Public Health

Background:

  • Knee osteoarthritis (OA) management and prevention increasingly focus on daily physical activity (PA).
  • Understanding the impact of different PA levels on knee replacement (KR) surgery incidence is crucial for patient outcomes.

Purpose of the Study:

  • To compare the effects of various hypothetical daily PA regimens on knee replacement (KR) surgery incidence.
  • To utilize a targeted learning approach for analyzing PA interventions in knee OA.

Main Methods:

  • Analysis of data from the Osteoarthritis Initiative (OAI) cohort of US adults with symptomatic knee OA or at risk.
  • Measurement of daily PA using the Physical Activity Scale for the Elderly (PASE) score.
  • Estimation of PA intervention effects on KR surgery incidence using a doubly robust targeted minimum loss-based estimator over 96 months.

Main Results:

  • Maintaining baseline PASE scores showed a KR surgery incidence of 4.71%.
  • Reducing PASE scores to 200 for individuals with scores >242 decreased KR incidence to 2.98%.
  • Moderate increases (10-20%) in PASE for low-activity individuals reduced KR risk, while larger increases (30-50%) offered diminishing returns.

Conclusions:

  • Optimizing daily PA levels, specifically by reducing excessive activity, benefits older adults at risk for or with knee OA.
  • Tailoring physical activity to an optimal level is the most effective strategy for reducing knee replacement surgery risk.