Osteoarthritis (OA) affects joints – it involves pain, inflammation, stiffness, weakness and damage to the cartilage surfaces. Is it common? You bet! The latest clinical care standards released this month in Australia estimate 2.1million Australians have osteoarthritis, with one in three over the age of 75 affected. How many other conditions are this prevalent?
Can we cure OA? No. But can we help? You bet! One of the mainstays of conservative care is exercise therapy, alongside a range of other options.
In this article we’ll summarise the large body of research on exercise therapy – does it help OA and are there any individual factors that affect whether exercise is suitable or not? The focus will be on the most common joints, the knee and hip, affected by OA.
Does Exercise Help OA?
Exercise therapy, which means exercise that makes you stronger, is recommended as a frontline conservative treatment for OA based on the results of multiple meta-analyses and randomised trials (Tierlink et al 2023).
In fact, the body of scientific evidence is overwhelming.
Exercise as a course of treatment results in a clinically relevant reduction in pain with beneficial effects still present 2-6 months after treatment.
Who does best with exercise for an arthritic knee or hip?
Some reports suggest that people who have fewer comorbidities (fewer diseases) and good mental health are more likely to respond to exercise therapy (defined as pain improvement of >30% from baseline) (Tierlink et al 2023). Co-existing conditions may simply make it harder for people to be consistent with their exercise program…. Other studies have demonstrated that people with obesity, swelling, significant changes on Xray, age, gender and a range of factors make no difference at all to your ability to improve with exercise (Young et al 2023). It appears that anyone who actually does the work tends to get better, so don't let other things prevent you from getting better!
Is any one type of exercise better for OA?
The short answer is no! The choice of exercise needs to be individualised to you and what your muscles and joints can perform properly. Whether this is high or low intensity exercise doesn’t seem to matter in terms of whether you start to feel better over time. Similarly strength work, aerobic conditioning and hydrotherapy all produce similar positive benefits. The choice should be based on patient preference and individual context.
How long do you need to work out for?
Most clinical trials look at exercise over 6-12 weeks periods, with patients working out daily or at least on alternate days (Young et al 2023). We’re not talking heavy weights in the gym here – it might be simple body weight drills and some light aerobic exercise (like cycling, walking or using a rowing machine).
Will exercise worsen the arthritis?
This has been studied, and no evidence has ever been found that cartilage damage is accelerated by therapeutic exercise (Young et al 2023). On the contrary, people tend to feel better with less pain and better function. There is even evidence that walking regularly helps prevent worsening of your joints…. Not to mention assists in many other aspects of your health like cardiovascular function!
Exercise as medicine:
If you have osteoarthritis what are you waiting for? Exercise can help, and has been shown to a key treatment for at least 26 diseases including OA (Pederson et al 2015)… So your overall health can receive an even bigger boost!
The key here is to form a new exercise habit, as the benefits continue whilst you continue to stay fit and strong.
You may require some professional assistance to get started and work out exactly what sort of exercise approach might be best suited to you, and you might need some clinical treatment to help reduce pain and swelling, and to improve arterial blood flow to get things functioning better to enable your new exercise habit to take off!
References:
Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the
Knee Clinical Care Standard. Sydney: ACSQHC; 2024.
Pedersen BK, Saltin B (2015): Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 25:1–72.
Tierlink CH et al (2023): Effect of exercise therapy in patients with hip osteoarthritis: A systematic
review and cumulative meta-analysis. Osteoarthritis and Cartilage Open https://doi.org/10.1016/j.ocarto.2023.100338.
Young JJ et al (2023): Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal
prescription? Curr Treat Options in Rheum 9:82–98.
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