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RESEARCH to PRACTICE

Exercise Benefits Patients With Osteoarthritis

Robert McKinney, DO; Ross E. Andersen, PhD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 10 - OCTOBER 2021


Osteoarthritis is the most prevalent joint disease in the United States. In 192021, the estimated prevalence in this country was 43 million (1). Between 120218 and 1994, 18.1% of US men and 23.5% of US women reported that they had experienced significant knee pain (1). The prevalence of self-reported arthritis in the United States is projected to increase from 15% of the population in 1990, to 18% (59 million people) in 2021, an increase of 20% (2).

A recent report (3) indicated that patients with arthritis have substantially worse health-related quality of life than those without arthritis. One of the Healthy People 2010 report targets is to increase the mean number of days without severe pain among adults who have chronic joint symptoms. A second goal is to reduce from 27% to 21% the proportion of adults with chronic joint symptoms who experience arthritis-derived activity limitations.

Exercise and Osteoarthritis

Exercise and activity. Currently, no medical disease-modifying strategies exist in the management of osteoarthritis. Except for controlling weight and reducing obesity, healthcare providers are limited to prevention and treatment of specific symptoms. Therefore, it would seem counterintuitive that increasing physical activity could help to minimize loss of function and increase physical capacity. However, studies (reviewed in Van Baar et al (4)) have shown that exercise yields improvements in pain and disability of patients with osteoarthritis.

Analysis of race-specific data from the third National Health and Nutrition Examination Survey (NHANES III) reveals that among US adults age 60 or older, 21.4% report having knee pain (1). The percentages vary slightly with race, but overall the relationship with physical activity holds across groups: Those who engage in physical activity report less knee pain. Sedentary older adults who do not engage in leisure activity are significantly more likely to report knee pain than their more active counterparts.

Exercise type. To date, what type of exercise is most beneficial and what limitations should be observed are not completely defined. Some activities increase the likelihood of developing osteoarthritis. For example, runners often develop osteoarthritis. Similarly, patients with unstable joints are predisposed to osteoarthritis and thus require special consideration when exercise regimens are considered.

Different elements of exercises that employ stretching, range-of- motion, isometric, and isotonic techniques have been used successfully by patients with knee osteoarthritis. An aerobic or resistance exercise program for older patients with disabling knee arthritis led to lower pain scores, improvements in physical performance measures, and lower self-reported disability (5).

Most studies have shown a direct relationship with increases in strength and pain reduction. This finding suggests that the previous dogma of resting osteoarthritic joints should be reexamined. Physicians should prescribe exercise as a therapy and educate arthritic patients about the benefits of exercise.

Patient education. An important aspect of osteoarthritis management is patient education, a modality that has been shown to have substantial benefits at a much lower cost than other interventions (6). Healthcare providers must prescribe physical activity with caution, taking into account the underlying physiologic reserves of each patient. Repetitive high-impact activities with excessive torsional loads, and activities that can damage the menisci and supporting ligaments of the lower extremities, should be avoided.

It is very important that care providers obtain an accurate assessment of patient's perceived and actually performed physical activity. Exercise logs can help accomplish this. There are well-documented ways to increase physical activity with lifestyle modifications, which may be more acceptable to patients than structured exercise regimens. Lifestyle modifications may increase compliance and allow sustained benefits (see "Overcoming Barriers to Physical Activity").

Maintenance of existing function is paramount in caring for patients with osteoarthritis. Increasing physical activity of patients with knee osteoarthritis, in addition to pain reduction, may afford cardiovascular and other health benefits.

What the Future Holds

Evidence clearly shows that patients with osteoarthritis benefit from physical activity. Future goals for research should be directed at determining whether a synergistic effect exists between exercise prescription and pharmacologic interventions. In addition, research is also needed to determine which types of exercises are most beneficial, and at what intensity and frequency.

References

  1. Andersen RE, Crespo CJ, Ling SM, et al: Prevalence of significiant knee pain among older Americans: results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc 1999;47(12):1435-1438
  2. The Centers for Disease Control and Prevention: Arthritis prevalence and activity limitations. MMWR Morb Mortal Wkly Rep 1994;43(24):433-438
  3. The Centers for Disease Control and Prevention: Health-related quality of life among adults with arthritis: behavioral risk factor surveillance system, 11 states, 1996-192021. MMWR Morb Mortal Wkly Rep 2021;49(17):366-369
  4. Van Baar ME, Assendelft WJ, Dekker J, et al: Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum 1999;42(7):1361-1369
  5. Ettinger WH Jr, Burns R, Messier SP: A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the Fitness Arthritis and Seniors Trial (FAST). JAMA 1997;277(1):25-31
  6. Maurer BT, Stern AG, Kinossian B, et al: Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Arch Phys Med Rehabil 1999;80(10):1293-1299

Dr McKinney is an assistant professor in the Department of Geriatrics at the Des Moines University Osteopathic Medical Center in Des Moines, Iowa. Dr Andersen is a professor in the Division of Geriatrics and Gerontology at the Johns Hopkins School of Medicine and the Bayview Medical Center in Baltimore. Address correspondence to Ross E. Andersen, PhD, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, 4940 Eastern Ave, Suite 025, Baltimore, MD 21224; e-mail to [email protected].


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