**Contents**



## **About the Editors**

**Rocco Papalia** graduated in Medicine and Surgery with honors from the Campus Bio-Medico University of Rome, and he completed the Residency Program in Orthopedics and Traumatology with honors at the Campus Bio-Medico University of Rome.

He completed a Ph.D. program in "Tissue Regeneration of the Locomotor System and Experimental Technological Applications" at the Campus Bio-Medico University of Rome. He is the author of several publications in international journals. He is a reviewer of scientific peer-reviewed papers for international orthopedics and traumatology journals. He completed several research and clinical fellowships in international university centers, including the Department of Orthopedics and Traumatology of the University of Pittsburgh (PA, USA), Division of Sports Medicine. In June 2009 and June 2010 he was a fellow of the San Diego Shoulder Course (San Diego, California), focusing on advanced research and surgical techniques on shoulder pathologies. He was also the winner of several international fellowships, including EFOST Traveling Fellowship (2012) and ESSKA Traveling Fellowship (2014). He is Director of the Orthopedics and Traumatology Unit of the Campus Bio-Medico University Hospital of Rome and Director of the Residency Program in Orthopaedics and Traumatology, and he has been Chairman of Diseases of the Locomotor System at Campus Bio-Medico University of Rome since 2016.

Currently, he is an active orthopedic surgeon, focusing his activity on the adult reconstruction of knee and hip and on arthroscopic surgery. He is also involved in several national and international research projects and clinical trials.

**Vincenzo Denaro** graduated in 1967 in medicine and surgery from the University of Catania. From 1967 to 1975 he was hospital assistant of the orthopedic clinics at S. Matteo Hospital in Pavia, Italy. He completed residency programs in Diseases of the Digestive System, Haematology, Orthopedics and Traumatology, Occupational Medicine, and Physiatry at the University of Pavia. From 1975 to 1987 he was Hospital Assistant at the Orthopedic Clinic of the San Matteo Clinic Hospital at the University of Pavia. From 1987 to 1994 he was Associate Professor at the University of Catania. From 1991 to 1994 he was Head of the Spine Pathology Service at the University of Catania. From 1994 to 2000 he was Associate Professor of Locomotor System Diseases at the Campus Bio-Medico University of Rome. From 1994 to 2016 he was Chairman of Diseases of the Locomotor System and Director of the Residency Program in Orthopedics and Traumatology at the Campus Bio-Medico University. From 2009 to 2014 he was Dean of the Faculty of Medicine and Surgery at the Campus Bio-Medico University. Since 2014 he has been President of the Italian Society of Spinal Surgery. He is now Professor Emeritus of Orthopedics and Traumatology and continues to be involved in several congresses and national and international research projects.

**Fabio Pigozzi** graduated in Medical Sciences (cum laude) at the Rome University "La Sapienza". He holds specialisations in Cardiology and Sports Medicine. He is Honorary Doctor in Sport Science at the Aristotle University of Thessaloniki, Greece; Profesor Honorario, Faculty of Medicine, Universidad de Buenos Aires, Argentina; and Doctorate "Honoris Causa" in Health Sciences, Catholic University San Antonio, Murcia, Spain.

He is Full Professor of Internal Medicine and Director of Sports Medicine Unit, University of Rome "Foro Italico". He has been Rector at the State Sports University of Rome "Foro Italico" (2013– 2019). He is Scientific Director of the FIFA (F´ed´eration Internationale de Football Association) Medical Center of Excellence of Rome (2010 to present). He is President of the International Federation of Sports Medicine (2010 to present). He was a member of the Health National Council (2009–2014) and the Technical Health Committee of the Ministry of Health (2015). He is a member of the Foundation Board (2015 to present) and of the Health, Medical and Research Committee of the World Anti-Doping Agency (WADA) (2008 to present). He is a member of the Medical Commission of the Association of the National Olympic Committees (ACNO) (2014 to present).

He has contributed to several topics in Sport Medicine and Sport Science, particularly cardiovascular response to physical exercise and training, physical medicine and rehabilitation, nutrition, and anti-doping. He has been the principal investigator in many national and international research projects, and he is the author of more than 200 scientific publications.

**Chiara Fossati** graduated in Medicine from "Sapienza" University of Rome in 2005. From the same University, she obtained a postgraduate degree in Geriatrics in 2009 and Ph.D. in Geriatric Sciences in 2013. She obtained a master's degree in Sports Cardiology in 2020.

In 2015 she started to direct her research interests towards exercise as prevention and treatment of chronic diseases. In 2017 she obtained a postdoctoral research gran<sup>t</sup> at University of Rome "Foro Italico" where she became Assistant Professor of Internal Medicine in 2019. She teaches Sports Medicine within bachelor degree course "Scienze Motorie e Sportive", University of Rome "Foro Italico". She is referent for Sports Medicine in the teaching staff of the Ph.D. programme at University of Rome "Foro Italico". She is Honorary School Fellow at the School of Sport and Service Management of Brighton University, UK.

Her scientific and research activities include the participation in many research projects (some of them cofunded by Italian institutions or the European Union) and international clinical trials (phase II–III), more than 40 full-text papers published in peer-reviewed international journals, 3 book chapters, and many articles published on the acts of national and international congresses.

## *Editorial* **Elderly or ageless? Physical Activity in the Aged Orthopaedic Patient**

**Fabio Pigozzi 1,\* and Vincenzo Denaro 2**


Received: 26 September 2020; Accepted: 29 September 2020; Published: 10 October 2020

Progression of osteoarthritis in the elderly is often a synonym of impaired function, discontinuation of physical activity and sport participation [1]. However, there is consistent evidence suggesting that the role of sports activity is of paramount importance in the whole natural history of osteoarthritis, as well as of degenerative disc disease. This contrast should be promptly faced by the orthopaedic surgeon, gerontologist and sports physician, to avoid early impairment or discontinuation of patient's activity. In fact, apart from preventing the onset of major symptoms and delaying the loss of function as primary and secondary prevention, exercise is extremely important to improving muscular conditioning and strength before surgery and for the post-operative recovery and rehabilitation.

According to the World Health Organization, the concept of physical activity refers to several entities, including light individual exercise, collective training, individual or team sports participation [2]. All of these activities have specific e ffects on the whole organism and allow the human body to remain healthy not only for musculoskeletal fitness but also for the improvement of cardiovascular, metabolic and psychosocial status. If this is especially true for young people, the elderly become ageless if they are able to stay fit, to stay healthy and to maintain the physical and mental fitness that allow them to face organ deterioration, functional impairment and possible major surgeries. From an economical and occupational perspective, it is worth underlining that, given the increased retirement age of citizens in Europe, preserving a good to excellent functional status is of paramount importance to improving productivity and avoiding early retirement and inability to work [3]. All of these features are enclosed within the framework of successful ageing, according to which the organism deterioration follows an ordered pathway to avoid patient discomfort and disability [4].

Therefore, physical activity represents complementary therapeutics for the managemen<sup>t</sup> of osteoarthritis and for other musculoskeletal degenerative diseases. A special focus of international research concerns the involvement of older patient in exercise programs as a conservative treatment, but also in the preoperative setting, to improve surgical outcomes [5]. It is a common experience for the orthopaedic surgeon that a fit patient has a faster and better recovery after a major surgical procedure, including joint arthroplasty, and next to clinical experience, the literature evidence is growing, reporting significant improvement of patient-reported outcomes either for pain or for function [6].

The aim of the present Special Issue is to collect the available evidence concerning the role of physical activity as a conservative treatment for large joint osteoarthritis and low back pain, and as prehabilitation and rehabilitation, before and after arthroplasty surgery. A systematic approach has been followed for evidence collection, and a meta-analytic methodology has been advocated in most of the papers, to ensure a comprehensive assessment of available data.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest
