Exercises That Are the Best for Osteoarthritis

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?