Exercise and recommendations for osteoarthritis
Osteoarthritis (OA) of the hip and knee joint is a condition that affects 20-30% of adults over the age of 50. This condition results in pain, functional limitations, and a reduction in quality of life. Many believe this condition is a general ‘wear and tear’ of the load-bearing joints that occurs over time due to aging, but as we learn more from recent science, this view has changed.
Many experts now agree that OA is the result of a complex ‘disease process’ and systemic inflammation, and is likely related to lifestyle habits. Consider this example: if OA was only related to the weight bearing joints such as the ankle, knee and hip, why do we see a relatively high rate of hand OA in the overweight and obese populations? This is a non-weight bearing joint, therefore this suggests that there is more to its cause than wear and tear.
There are a few risk factors for lower-limb OA such as having a significant physical trauma to the hip or knee, previous surgical procedures, and strong family history (inherited/genetic OA). However, more and more commonly we are seeing a ‘metabolic OA’ from the inflammatory features of abdominal and visceral obesity, hypertension, elevated cholesterol and triglycerides, and type II diabetes. This begs the following question: is OA driven by an increase in body weight thereby increasing joint load, or is the inflammation driven by visceral fat leading to a less resilient hip or knee?
Answer: there are likely contributions from both. If there is an increase in the lower limbs’ load, the metabolic factors may influence the internal environment that produces less resilient cells and tissues that are produced.
Fortunately, there are excellent options available to improve pain, mobility and ability to engage with life.
Here are the first-line evidenced-informed interventions for treatment of hip and knee OA:
Anti-inflammatory medication will reduce pain temporarily, but is not the long-term fix you’re likely looking for. Reductions in body weight have been studied extensively with some trials showing that obese patients who lost 10% of their body weight had a 50% reduction in their pain levels. Weight loss occurs primarily through diet and consistent physical activity, although stress and sleep management also play a role. In conjunction with dietary changes, exercise has to occur. There are over 50 randomized control trials that support the efficacy of exercise in the treatment of patients with painful knee OA and dozens more for hip OA.
Here are the latest recommendations that come from GLA:D®, an international evidence-based program for the treatment and management of osteoarthritis:
Find exercises that are specifically tailored and targeted to your needs and preferences.
Consider aquatic exercise if completing land-based exercise is currently too challenging.
Complete at least two 30-60 minute supervised exercise sessions for six weeks.
An additional one or two sessions per week will optimize outcomes.
Extending programs to 12 weeks and beyond will optimize strength gains and functional outcomes.
Consider booster sessions with your physiotherapist to enhance goal attainment and progression.
Ensure you know how to manage pain flares and inflammation, including how to modify exercise and physical activity.
Beyond GLA:D®, there are several other international guidelines that also support the efficacy of exercise for OA.
There is an overwhelming abundance of data highlighting the importance of exercise for the management of OA. If your looking for a place to get started, consult with one of our physiotherapists to get you started on a path to recovery.
In case you want to learn more, here are some notable resources: EULAR, OARSI, National Institute for Health and Care Excellence, and Ottawa Panel Clinical Practice Guideline.
Skou et al. Physical activity and exercise therapy benefits more than just symptoms and impairments in people with hip and knee osteoarthritis. JOSPT. 2018.
By Nathan Hers, Physiotherapist