Living well with Osteoarthritis

What is osteoarthritis?

Arthritis is a condition causing inflammation and pain in a joint. Osteoarthritis is the most common type of arthritis.

In osteoarthritis, there is a slow breakdown of the joint’s cartilage (cartilage covers the ends of bone and protects bones from rubbing against one another). This breakdown of cartilage can be due to joint misalignment or abnormality, instability, injury or trauma, or other conditions such as rheumatoid arthritis, or obesity. A loss of muscle strength can predict the onset and progression of osteoarthritis.

Over time, the breakdown of cartilage causes the underlying bone to become exposed, leading to pain, stiffness, decreased range of motion, deformity, and loss of joint function.

In some people, these symptoms may be mild and may come and go. In others, the symptoms are continuously present and may make it hard to carry out activities of daily living.

Osteoarthritis most often develops in people aged 45 and over and in people with a family history. Osteoarthritis also occurs slightly more often in women and is more often seen in certain occupations. The joints most often affected are in the hands, hips, and knees.

Unfortunately, many people with arthritis stop exercising because of the false belief that physical activity and exercise worsen symptoms or disease progression. While there is no cure for osteoarthritis, exercise has not been shown to exacerbate osteoarthritis symptoms or accelerate disease progression. In fact, most symptoms are well managed with exercise. Exercises to strengthen the muscles around the joint are especially helpful in improving and maintaining functional use of the joint.

What does the latest research say about exercise for people living with osteoarthritis?

This research review (DOI: 10.1136/bjsports-2015-095424) found that people who exercised had significantly reduced pain, improved physical functioning, and improved quality of life when compared to people in non-exercising control groups.

For people presenting with pain as a symptom of osteoarthritis, a 2022 research review (DOI: 10.2519/jospt.2022.10490) found that when comparing exercise to opioids and anti-inflammatory drugs, exercise ranked as the best treatment for osteoarthritis pain.

These research reviews reinforce the importance of exercise participation for pain management and overall quality of life. Exercise may also lead to a decreased reliance on pain medications over time.

In 2019, the American College of Rheumatology and the Arthritis Foundation collaborated to present guidelines for the management of osteoarthritis (DOI: 10.1002/acr.24131). Strengthening exercise was strongly recommended for hand, knee, and hip osteoarthritis. Weight loss (for those who are overweight) and tai chi were recommended for knee and hip osteoarthritis only. Strong recommendations were not made for balance training, yoga, heat or cooling therapy, acupuncture, or kinesiotaping.

In 2022, NICE (National Institute for Health and Care Excellence) also published guidelines on the diagnosis and management of osteoarthritis (https://www.nice.org.uk/guidance/ng226/chapter/Recommendations#non-pharmacological-management). These guidelines state that exercise is the core treatment for this condition and should be offered to all people living with osteoarthritis.

Share article

Share this article with a friend

How can I live well with osteoarthritis?

Here are some tips to live well with osteoarthritis

• Do not be afraid to move your joints. Resting painful joints feels comfortable at first but remaining sedentary for too long may increase pain and joint stiffness, and decrease your range of motion.
  
• Start low and go slow.If you’re new to exercise, start with low-intensity exercise and gradually progress. Higher-intensity exercise comes with more health benefits, but even low-intensity exercise is better than remaining sedentary.
  
• People with osteoarthritis should continue to follow the UK’s Chief Medical Officers’ Physical Activity Guidelines (https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report).
  
• Participate in aerobic exercise. Try to reach at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week. Some options include swimming, cycling, running, or playing sports. If you can, choose an option that is fun and has a social component.
  
• Participate in progressive resistance exercise. At least 2 days per week, perform strength exercises for all major muscle groups in the upper and lower body, especially those muscles surrounding the affected joint(s). For example, people with knee osteoarthritis should include exercises that work the quadriceps (upper thigh muscles). Resistance can be provided by machines, dumbbells, resistance bands, or body weight. Beginners can start with 2-3 sets of 8-12 repetitions with good form. More active adults can progress to fewer repetitions with greater resistance. For both beginners and more active adults, the last repetition you perform should feel difficult to complete. If the last repetition was easy, the resistance is too low and should be increased.
  
• Minimise sedentary time. Breaking up periods of inactivity is important for your overall health and may decrease joint stiffness experienced throughout the day.
  
• In most cases, modification of exercise is preferable to complete cessation of physical activity. If it is excessively painful to move the joint through the entire range of motion, modify the range of motion to a more tolerable range. Other modifications can be made by your exercise professional to enable gripping (in case of hand deformity), reducing exercise intensity during flare-ups, and stability/support mechanisms for joints and balance deficits.

Overall, the benefits of exercise in people with osteoarthritis are well documented and include decreased pain, increased muscle, bone, and joint strength and stability, and increased joint mobility. Regular exercise will also help to maintain joint function, independence, and quality of life well into later life.

Goldster offers a range of aerobic and resistance exercise classes for both beginners and more active adults. These classes are always supervised by expert trainers who are able to modify exercises for those living with health conditions, such as osteoarthritis.

Stay strong,

Dr. Ashley Gluchowski, CSEP-CEP, CSPS