Osteoarthritis (OA) and Exercise

What is Osteoarthritis?

Osteoarthritis (OA) is a common chronic disorder of the joints that predominantly affects older people but can also affect younger individuals following joint injury. The most common joints affected by OA are those of the hips, knees, big toe, spine and hands.

How does exercise help?

All clinical guidelines recommend exercise to manage osteoarthritis (the only interventions to get a strong recommendation from the RACGP are land-based exercises and weight management - both of which benefit from EP intervention).

Considerable research shows that exercise benefits people with a wide range of disease severities, including people with severe pain or changes seen on X-ray. 

Overall, exercise is more effective in relieving symptoms than pain medications and anti-inflammatory drugs. Exercise is also safer and has fewer side effects. 

Exercise can help to:

  • Reduce pain
  • Increase muscle strength
  • Improve the range of joint motion
  • Improve balance
  • Prevent de-conditioning (loss of fitness and muscle wasting)
  • Improve physical function
  • Improve wellbeing

What type of exercise is best?

Many types of exercise are beneficial for people with OA. Choose a type of exercise that you enjoy and can easily incorporate into your daily life. Strength (resistance) training and/or aerobic exercise are recommended forms of exercise.

  • Strength training can be performed at home or at the gym (in our Strong Room). The thigh, hip and calf muscles are often weak in people with OA. Resistance can be applied with weights, elastic tubing or body weight.

  • Aerobic exercise may include walking, cycling, or using a rowing machine or a seated stepper.

  • Aquatic (water) exercise can be a useful gateway to land-based exercises. The water buoyancy minimises the load on the joints and reduces pain on weight-bearing. On its own aquatic exercise only gets a conditional recommendation from the RACGP.

  • Other types of beneficial exercise include tai chi, balance exercises, and stretching to improve the range of joint motion and flexibility.

Before starting a physical exercise program, it is recommended that you receive a comprehensive assessment by an appropriately qualified health care provider, an Exercise Physiologist (EP). This assessment should include clinical evaluation of your osteoarthritis and should identify any other health conditions that may be worsened by exercise.

Key Points to Remember

  • Aim to exercise 4–5 times per week for at least 30 minutes.

  • Some discomfort in the affected joint during exercise is normal and does not indicate a worsening of the osteoarthritis. A substantial increase in pain or swelling during or following exercise can suggest that modifications are needed.

  • Begin the program slowly and progress gradually.

  • You will gain the greatest benefits if you perform the exercises regularly.

  • Because benefits are lost if you stop exercising. Use strategies to help you continue - keep a logbook, set achievable goals, ask for support from a partner, family or friends, and vary your exercise program.

  • A health practitioner overseeing your exercise program can improve results.

  • You may choose to do your exercise program at home, in a gym or in a group setting.

  • If you are overweight, losing weight by modifying your diet will improve the outcomes of your exercise program.

References

PridePlus Health - Exercise Physiology https://prideplus.com.au/exercise-physiology/

PridePlus Health - For Referrers https://prideplus.com.au/referrers/

PridePlus Health - Blog https://prideplus.com.au/blog/

Exercise is Medicine Australia www.exerciseismedicine.org.au

Exercise Right www.exerciseright.com.au

1. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport 2011; 14(1): 4–9.

2. Uthman, O. A., et al. (2013). "Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis." BMJ 347: f5555.

3. Juhl C, Christensen R, Roos EM et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: A systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheum 2013 epub

4. Lange AK, Vanwanseele B, Singh MAF. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Rheum 2008; 59(10):1488–94

5. Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 2013; 310:1263-1273

6. The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.

A PridePlus Health Case Study on Osteoarthritis

Background

“It hurts all the time”

A 63-year-old male with persistent knee pain for the past 3 years after a work injury, at time of injury, had mild OA of left knee but symptoms gradually worsened with time. 

Reduction in movement capacity and function, time off work, difficulty sleeping due to pain, reliance on Mobic (a strong anti-inflammatory pain medication), unable to climb or descend stairs, struggles walking in shopping centres, emotional stress as a result. 

Impending knee replacement surgery. 

No structured or targeted exercise rehabilitation plan recently.

Goals

Increase walking for health and wellbeing

Reduce pain

Reduce the intake of pain medications

Return to daily activities and work duties such as using stairs, getting in and out of vehicles, up and down from seated positions, improve sleep hygiene

Baseline Assessment

Unilateral knee OA (moderate/severe on imaging)

De-conditioned left hip and knee stabilisers, de-conditioned core stabilisers, quadriceps, and distal leg musculature

Unable to perform single-leg stand or modified squat or double bridge or single bridge (back pain)

Program and Team

Referred by GP to EP for 5 x one on one consultations 

Treatment over 8 weeks, initially weekly for 2 weeks, then second weekly at weeks 4, 6, 8. 

Gait focus, stability and strength focus, education about pain, reassurance and support, goal focused approach 

Encouraged to use functional exercises at home and when returning to work

Home tasks performed

Exercise task specific

Progress

Re-assessment at 4 and 8 weeks 

Can perform bridges 5 x 30 seconds with good activation of key core / hip / leg muscles and no knee pain, single-leg bridges, single-leg stands, can perform weighted squats (12kg) to a knee flexion range of 90 degrees, can perform step-ups with minimal pain and good recruitment of postural and global muscles

Outcome

“It only hurts when I do too much whereas before it was always on my mind”.

Has returned to work 0.8, can walk further without pain, only takes medications when needs to, is more educated about how to move efficiently and safely.

mike exercise physiologist pascoe vale

“Functional exercises enabled the client to understand his movement patterns, helped him regain strength and independence whilst reducing pain, and improved his quality of life” - EP Mike Fitzsimon