Osteoarthritis and Physical Activity – Are Patients Doing Their Part?

Osteoarthritis (OA) is a common condition whose prevalence increases with age. Although there is currently no “cure” for OA, treatment often focuses on pain control and maintenance of joint function. The hallmarks of joint function maintenance are weight loss (if appropriate), assistive devices (e.g., walker, cane), and therapeutic exercise.

Therapeutic exercise regimens for OA typically target muscle strengthening and aerobic activity. Studies evaluating the efficacy of muscle strengthening exercises in patients with OA of the hip and knee have been shown to have positive results1 including decreased pain. Aerobic exercise has also been shown to be beneficial for people with OA of the hip and knee2, with studies showing that people who participate in exercise such as walking, running, cycling, or aquatics reported improvements in:

  • – Increased aerobic capacity
  • – Decreased depression and anxiety
  • – Increased physical activity
  • – Decreased fatigue
  • – Increased muscular strength and flexibility
  • – Decreased pain
  • – Increased functional status

Despite this evidence, a recent article in the October 5, 2011 issue of the Journal of the American Medical Association (JAMA)3, reported on a recent study of a sample of patients with osteoarthritis of the knee and their low levels of physical activity.

In this study, researchers monitored 1,111 adults with osteoarthritis of the knee with accelerometers and found that 40.1% of male and 56.5% of female subjects were inactive during a 7-day period. In fact, only a small percentage of the men (12.9%) and women (7.7%) in the study even met national activity guidelines4.

This article goes on to note that the topic is important to all health care providers because as the U.S. population ages, osteoarthritis cases are expected to soar, with 67 million people in the United States expected to have physician-diagnosed osteoarthritis by 2030.

The message from these researchers is that physical activity for people with osteoarthritis is not only usually safe, but a very effective way to deal with pain and stiffness and increase mobility. Unfortunately, it is not unusual for people with osteoarthritis to think that their joint pain means that they have to slow down.

Among recommended physical activity guidelines for adults4, The U.S. Department of Health and Human Services advises 2.5 hours a week of moderate-intensity physical activity. They recommend that older adults should be as physically active as their abilities and conditions allow. Their specific recommendation is that “All older adults should avoid inactivity. Some physical activity is better than none and older adults who participate in any amount of physical activity gain some health benefits.

Convincing a patient with osteoarthritis pain that exercise is good for them, and encouraging them to get up off the couch, could sometimes be a “hard sell”. Describing that exercise may not only help with stiffness, but also can help relieve depression, and even help with weight control, is important. Teaching patients that there are things that they can do to self-manage their pain, in addition to prescribed treatments, can be beneficial and can fortify the patient-centered medical home model of health care.

PainEDU’s sister site for people living with chronic pain, painACTION.com, has just launched a new module devoted to patients with arthritis pain. Increasing activity as a pain management strategy is a major theme on the site. One of the articles, titled “Fun ways to be physically active when you have arthritis”, mentions yoga, pilates, stretching, and Wii® fitness programs.

The painACTION module on arthritis focuses on low impact self-management exercise solutions, such as ‘chair yoga’, an activity which does not stress the joints. In this lesson, users can learn yoga positions by following a videotape narrated by a certified yoga instructor, step by step. They can then use the yoga video tool and proceed, at their own pace, through a 40-minute chair yoga session.

References

  1. 1. Hopman-Rock M, Westhoff MH. The effects of a health educational and exercise program for older adults with osteoarthritis of the hip or knee. J Rheumatology. 2000;27(8):1947–1954.
  2. 2. Brosseau L, MacLeay L, Welch V, Tugwell P, Wells GA. Intensity of exercise for the treatment of osteoarthritis. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD004259. DOI: 10.1002/14651858.CD004259. Edited (no change to conclusions), published in Issue 7, 2010.
  3. 3. Voelker R. Few adults with knee osteoarthritis meet national guidelines for physical activity. JAMA. 2011 Oct 5;306(13):1428, 1430.
  4. 4. Physical Activity Guidelines for Americans, US Health and Human Services http://www.health.gov/paguidelines