Physical activity for osteoarthritis

Barker, 2014 Bartels, 2016 Bennell, 2015 Bennell, 2011 Brosseau, 2016 Dobson, 2016 Messier, 2021

Exercise is important for all patients with osteoarthritis, irrespective of the affected joints or the stage or severity of disease (including for patients awaiting surgery). Reported benefits of exercise include reduced pain, improved physical function and quality of life, and a positive impact on comorbidities commonly associated with osteoarthritis (eg obesity).

A summary of the key points for physical activity for osteoarthritis is in Key points for physical activity for osteoarthritis.

Figure 1. Key points for physical activity for osteoarthritis

Exercise is important for everyone with osteoarthritis.
No one strategy has been shown to be better than others so choose one that suits the patient.
Involve patient supports; this might include a clinician if the patient has substantial functional impairment.
Consider analgesia as an aid for physical activity.
Reassure the patient that exercise does not cause damage despite provoking pain.

No specific exercise program has been proven to be substantially better than another in the management of osteoarthritis. The success of exercise depends on patient adherence to the program in the long term, so choice of exercise program should take into account the patient’s functional impairments, comorbidities and physical activity preferences.

For osteoarthritis of the knee or hip, programs that incorporate aerobic exercise with functional and progressive lower limb muscle strengthening are generally recommended. These have been shown to be safe and effective, even among older patients. Strengthening and aerobic exercise should be undertaken at least 3 times per week. People with lower limb osteoarthritis have an increased risk of falls, so balance training should also be incorporated as part of functional exercise. There is evidence that a program of strengthening, flexibility and functional exercises can delay the need for surgery in patients with hip osteoarthritis.

In terms of specific modes of exercise for knee or hip osteoarthritis, there is evidence for both land-based exercises, including mind-body exercises (eg Tai Chi and yoga), and water-based exercises, including aqua aerobics. An example of an exercise program for knee osteoarthritis is available on the HANDI (Handbook of Non-Drug Interventions) website.

For osteoarthritis of other joints, a functional exercise approach is recommended. For discussion of exercise for hand osteoarthritis, see Osteoarthritis of the hand.

Regular aerobic exercise has multiple well-recognised general health benefits that are relevant to patients with osteoarthritis. These include reduced risk of cardiovascular disease, weight loss, improved quality of life, mood and sleep patterns, and reduced risk of falling in older people. Weight loss is particularly important because obesity is a modifiable risk factor for the development and progression of osteoarthritis.

Patients with osteoarthritis often need additional encouragement to undertake exercise because of joint pain and perceived instability. Reassure patients that some discomfort at the affected joint during exercise is likely and this does not indicate disease progression. Encourage patients using supportive and noncatastrophic language such as ‘hurt does not mean harm’ and ‘sore but safe’. Topical or oral analgesia may be required to facilitate exercise.

Note: Reassure patients that some discomfort at the affected joint during exercise is likely and this does not indicate disease progression.

Appropriate exercise can be undertaken safely in a variety of settings (eg home, gym, group class). Referral to an appropriate health professional (eg physiotherapist, exercise physiologist) may be beneficial to initiate and reinforce an exercise program; this may include prescribing a personalised program of simple exercises (eg swimming, walking) that the patient can do unsupervised. Involving the patient’s social supports (eg family, friends) in the exercise program may also improve outcomes.

Depending on their functional impairments and comorbidities, some patients may require clinician-guided exercise instruction and support, combined with cognitive and behavioural pain education. In patients with knee osteoarthritis, physiotherapist-delivered exercise integrated with training in pain-coping skills has been demonstrated to improve functional outcomes, compared with either intervention alone.

In patients with hip or knee osteoarthritis causing a significant impact on walking or joint stability, a cane or tibiofemoral knee brace may be useful. See Physical treatments for osteoarthritis for advice on adjunctive therapies, which can supplement exercise.