Arthritis Archives - Orthopedic & Sports Medicine

Exercises That Are the Best for Osteoarthritis

in Arthritis, Health & Wellness, Osteoarthritis

Although scientists have shown that exercise can alleviate the pain of osteoarthritis, previous studies investigating which type of exercise is most beneficial have been inconclusive.

A new systematic review and network meta-analysis compiles data from multiple studies to find a clearer answer.

Published in the BMJ, the authors conclude that aerobic activities may be best for reducing pain. They also appeared better for overall function, gait performance (or the effectiveness of a person’s walking pattern), and, importantly, quality of life.

Why is osteoarthritis becoming more prevalent?

Osteoarthritis is a degenerative joint disease. Unlike rheumatoid arthritis, which is driven by an autoimmune reaction, osteoarthritis is caused by “wear and tear.”

Specifically, cartilage, which prevents bones from rubbing together at joints, is slowly degraded, causing pain and a loss of function. Most commonly, osteoarthritis affects the knee joint.

Osteoarthritis is becoming more prevalent. This increase is likely for a number of reasons, but two are particularly important. Firstly, it is increasing in line with the rise in obesity, which puts additional stress on joints. Secondly, because osteoarthritis is primarily associated with advanced age, the rising average age of the population also plays a part.

According to the authors of the new analysis, approximately 1 in 3 people over the age of 45 already have signs of osteoarthritis. More worryingly, half of these individuals already have severe knee symptoms.

Although there is a range of treatments, including medications, exercise should form an important part of the treatment plan. However, which exercise modality is best is still an open question.

The authors of the new paper write, “Many earlier studies failed to capture the full range of exercise types, leading to incomplete comparisons and reduced generalisability.”

Also, because osteoarthritis is a long term, progressive condition, they believe that not enough research has assessed the “short, medium, and long-term outcomes.”

Their new analysis helps bring some clarity to this important question.

Finding exercises that reduce pain, improve function

As with any difficult-to-answer question, analyzing large amounts of good-quality data is a good way to develop a clearer picture.

In this case, the scientists combined data from 217 randomized controlled trials (RCTs), including a total of 15,684 participants.

All of the included studies focused on knee osteoarthritis only. Additionally, they all compared some form of exercise to either a control condition or another form of exercise. Studies also had to take into account at least one of these outcomes:

function
pain
quality of life
how well they could walk
adverse events

Importantly, the authors also assessed each trial for its quality, including the risk of bias. Using this and other information, the researchers were able to evaluate the certainty of the evidence.

Which exercise is best for osteoarthritis?

Once they had crunched many, many numbers, they concluded that, compared with control participants, aerobic exercises improved:

Pain: Short-term and mid-term follow-up.
Function: Short-term, mid-term, and long-term follow-up.
Gait performance (Walking ability:) Short-term and mid-term follow-up.
Quality of life: Short-term and mid-term follow-up.

However, other types of exercise also had benefits. Mind-body exercise, which combines cognitive focus and breathing exercises with physical activity, seemed to increase function.

Also, neuromotor exercises, which focus on aspects such as balance, coordination, walking, and agility, were particularly beneficial for walking ability in the short term.

Strength training and mixed exercise seemed to produce large increases in function at mid-term follow-up, and flexibility exercises resulted in significant pain reduction in the long term.

Importantly, none of the exercise types caused any more adverse events than was experienced by those in the control groups.

Inevitable limitations of the study

This study has limitations. Notably, it only applies to people with knee osteoarthritis — studies on people with knee and hip osteoarthritis, for instance, were removed from the analysis.

They also explain that many of the studies on this topic are not of high quality, and call for larger and higher-quality studies. Importantly, only 5.5% of the studies looked at longer-term outcomes, which is an important omission when attempting to understand a lifelong condition like osteoarthritis.

When we asked about limitations, he said, “This was a well-designed and thoughtfully executed study. The researchers did an excellent job pulling together a massive amount of data and organizing it in a way that gives us a clearer picture than we’ve had before.”

“That said, no study is perfect,” he continued. “One of the biggest challenges here is that it groups very different activities into broad categories. Walking, cycling, and swimming are all considered ‘aerobic,’ but anyone with knee arthritis knows these don’t feel remotely the same.”

Will this change clinical advice for osteoarthritis?

Although aerobic activity is already recommended, it is given a similar weight to other modalities.

“What surprised me most,” she continued, “was how much of a difference these activities made across so many people and types of exercise programs.”

In line with their findings, the authors recommend “aerobic exercise as a first-line intervention for knee osteoarthritis management, particularly when the aim is to improve functional capacity and reduce pain. While other exercises may offer complementary benefits to patients, they should not replace aerobic exercise as the primary strategy.”

Taken together, Caravelli told MNT that the study “suggests that regular movement is one of the most powerful tools we have.”

The authors of the new study recommend regular indulgence in aerobic activities, like cycling, walking, and swimming. However, they also explain that it is important to speak with your doctor before adopting new exercise routines.

“We often assume that if we have arthritis, our best days are behind us, or that we’re on a fixed path toward joint replacement. But that’s not always true,” concludes Bennett.

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Exercise Helps Ease Arthritis Pain and Stiffness

in Arthritis

Article featured on Mayo Clinic

Everyone needs exercise, but it’s especially important for people with arthritis. Exercise increases strength and makes moving easier. Exercise reduces joint pain and helps fight tiredness.

Of course, when joints are stiff and painful, the thought of walking around the block or swimming a few laps might seem like too much. There’s no need to run a marathon or swim for miles. Even moderate exercise can ease pain and help you stay at a healthy weight. In short, when arthritis tries to slow you down, exercise can keep you moving.

Why is exercise needed

The right kinds of exercise can improve health and fitness without hurting joints. Combined with a treatment program, exercise can add to quality of life. And it can:

Strengthen muscles around joints.
Help maintain bone strength.
Increase energy.
Make it easier to sleep well.
Help control weight.
Improve balance.
Improve mood.

Bones need strong muscles for support. Not exercising weakens those supporting muscles. Weak muscles put more stress on joints.

Check with your health care provider first

Talk to your care provider about making exercise a part of your treatment. The best exercises depend on the type of arthritis and which joints the arthritis is in. A member of your health care team, such as a physical therapist, can work with you to find the exercise plan that’s best for you.

Exercises for arthritis

Exercises for arthritis might include exercises that put joints through their full range of motion and strengthening exercises. Exercise that raises heart rate, known as aerobic exercise, is also important.

Range-of-motion exercises

These exercises lessen stiffness and put joints through their full range of motion. Examples of these exercises are stretching arms up high or rolling shoulders forward and backward. Most of these exercises can be done every day.

Strengthening exercises

These exercises help build strong muscles that can support and protect the joints. Weight training is an example of exercise that can help build and keep muscle strength. Using resistance bands, hand weights or machines can help build strength.

Weight training should be done every other day for at least two days a week. It should include all the major muscles in the body.

Aerobic exercise

Exercises that raise heart rate, known as aerobic exercises, help with overall fitness. They can improve heart and lung health, help control weight, and increase energy.

Examples of aerobic exercises that are easy on joints include walking, bicycling, swimming and water aerobics. Try to work up to 150 minutes of somewhat hard aerobic exercise every week. You can exercise 10 minutes at a time if that’s easier on your joints.

It’s best to do moderate aerobic activity most days of the week. But even a couple of days a week can help. Exercise at a rate at which breathing is harder than usual while still being able to talk.

Other activities

Any movement, no matter how small, can help. Daily activities such as mowing the lawn, raking leaves and walking the dog count.

Exercises that focus on how the body moves, such as gentle forms of yoga or tai chi, also can help. They can improve balance and posture, prevent falls, and ease tenseness.

If you’re in an exercise class, tell your teacher about your arthritis. Listen to your body. Don’t do anything that causes pain.

Tips to protect your joints

If you haven’t exercised in a while, start slowly. Don’t push yourself too hard — that can overwork muscles and make joint pain worse.

Consider these tips:

Keep the impact low. Low-impact exercises help keep joint stress low while you move. Examples include stationary or recumbent bicycling, elliptical trainer workouts, or exercise in the water.
Use heat. Heat can relax joints and muscles and lessen pain before exercise. Deliver the heat with warm towels, hot packs or a shower. The temperature should be warm, not painfully hot. Use for about 20 minutes.
Move gently. Move joints gently at first to warm up. You might begin with range-of-motion exercises for 5 to 10 minutes before you move on to strengthening or aerobic exercises.
Go slowly. Exercise with slow and easy movements. If you feel pain, take a break. Sharp pain and pain that’s worse than the usual joint pain might mean something is wrong. Slow down if you see swelling or redness in your joints.
Ice afterward. Use ice on your joints for up to 20 minutes as needed after activity. This is even more important if your joints are swollen.

Listen to your body. Don’t push too hard. Build up slowly. Add more and harder exercise as you get stronger.

Don’t overdo

You might feel some pain and stiffness after exercise if you haven’t been active for a while. In general, if pain lasts more than two hours after exercise, you might be pushing too hard. You might need to exercise less often or for less time. Talk to your health care provider about how to know when pain is a sign of something more serious.

If you have rheumatoid arthritis, ask your provider if you should exercise during flares. You might work through your joint flares by doing only range-of-motion exercises. Or you might exercise in water. Even during a flare, it’s good to keep your body moving.