Exercise in osteoarthritis: Moving from prescription to adherence

Abstract

Exercise is recommended for the management of osteoarthritis (OA) in all clinical guidelines irrespective of disease severity, pain levels, and functional status. For knee OA, evidence supports the benefits of various types of exercise for improving pain and function in the short term. However, there is much less research investigating the effects of exercise in patients with OA at other joints such as the hip and hand. It is important to note that while the magnitude of exercise benefits may be considered small to moderate, these effects are comparable to reported estimates for simple analgesics and oral nonsteroidal anti-inflammatory drugs for OA pain but exercise has much fewer side effects. Exercise prescription should be individualized based on assessment findings and be patient centered involving shared decision making between the patient and clinician. Given that patient adherence to exercise declines over time, appropriate attention should be pain as reduced adherence attenuates the benefits of exercise. Given this, barriers and facilitators to exercise should be identified and strategies to maximize long-term adherence to exercise implemented.

Introduction

Osteoarthritis (OA) is a chronic joint disease commonly affecting the joints of the knee, hip, and hand. People with OA report pain, difficulty performing activities of daily living, sleep problems, and fatigue. They present with a range of physical impairments including joint stiffness, muscle weakness, altered proprioception, reduced balance, and gait abnormalities. In addition to these, psychological impairments such as depression and anxiety are common.

Exercise is an integral component of conservative management for OA and is universally recommended by clinical guidelines , irrespective of patient age, joint involved, radiographic disease severity, pain intensity, functional levels, and comorbidities. Exercise prescription should be individualized based on assessment findings and be patient centered involving shared decision making between the patient and clinician. This chapter reviews the role of exercise in the management of OA. OA in general is covered, but knee OA is a primary focus given that this is the most common lower limb joint affected and that the majority of OA exercise research involves the knee joint.

The first section of the chapter highlights the evidence supporting the effectiveness of exercise in managing symptoms of OA. Following this, practical recommendations are made regarding specific exercise prescription in terms of type, dosage, and delivery methods as well as ways to assess and monitor the outcomes of exercise in individual patients. The subsequent sections cover issues related to implementation of exercise by clinicians and patients. While there is evidence to support the use of exercise, clinicians are not routinely recommending exercise to patients and potential reasons for this are explored. Given that patient adherence to exercise declines over time, appropriate attention should be pain as reduced adherence attenuates the benefits of exercise. Facilitators and barriers to exercise adherence are discussed and practical strategies to improve patient adherence to exercise are provided.

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