Osteoarthritis: how to counsel on exercise

Written by Jenny Bong, U of T APPE Student

Osteoarthritis (OA) is a progressive disease affecting joints that lead to the breakdown of joint cartilage and the underlying bone.  Current drug therapies available for OA help manage pain and function, but unfortunately do not delay the progression of the disease. Incorporating non-pharmacological therapies has become a critical component in OA treatment, and pharmacists can make a positive impact by emphasizing exercise counselling to these patients.

Evidence shows that exercise in OA patients leads to the reduction of pain and improvement of mobility. Studies also show that exercise does not accelerate the development of osteoarthritis, provided injury is avoided. Patients should be educated on how to exercise effectively and safely.

Current evidence supports three main types of exercises:

  1. Mobility/Range of Motion
  2. Aerobic/Endurance
  3. Strengthening

Multiple references recommend incorporating all three types of exercise, but this may be limited by the patient’s ability to carry out the exercise. Therefore, the available options should be presented to the patient and individualized based on their physical abilities and comfort level.

Type of Exercise
 Description
 Goal
 How does it help OA symptoms?
Examples of Activity
Mobility/range of motion
Involves moving each joint through its full range of motion
To maintain a healthy range-of-motion
· Allows for increased functional capacity (especially in elderly)
·  Increased functional capacity improves activities of daily living (ADLs)
Yoga
Pilates
Tai Chi
Aerobic/Endurance
Involves any activity that develops cardiovascular and pulmonary fitness
Weight loss
· Weight is a contributing factor to OA
· Weight loss relieves stress on the joints
Running
Walking
  Swimming
Cycling
Strengthening
Involves strengthening the muscles supporting the joints
To strengthen the muscles for joint support
· Decreases stress on the bones of weight-bearing joints
· Knee-strengthening exercises can reduce pain, improve ease of walking, getting up from a chair, and climbing stairs
For the knee:
· Knee extensions
· Lying Leg Lifts
For the hips:
· Standing hip flexor stretch
· Knee to chest

For OA patients who are overweight, aerobic/endurance exercises are particularly important as it can lead to weight loss. According to Hopkins Arthritis, being only ten pounds overweight increases the force on the knee by 30-60 pounds with each step. This type of exercise is also particularly important for overweight patients as overweight women have nearly four times the risk of knee OA; for overweight men the risk is five times greater.

Currently, there is no optimal exercise “dosage” for the treatment of OA. Studies comparing high-intensity exercise to low-intensity exercise have not revealed any significant differences to date.  Although these studies involve small sample sizes, there are ongoing studies with larger population groups which may help us better understand what the optimal exercise therapy and duration is for patients with OA.

Here are some tips you can provide to your patients to prevent injury during exercise:

  • Warm up for at least 10 minutes. This improves circulation and prepares the joints for exercise.
  • Walk on flat, level surfaces, especially if OA is affecting the knees, hips or feet.
  • Recommend wearing supportive clothing such as athletic shoes, shoe inserts, knee braces, etc.
  • Avoid sports/activities that involve jarring movements (e.g. tennis, basketball).
  • Avoid excess pain medication prior to exercise – this may lead to over-exercising.
  • Stop exercising if you experience new onset of joint popping, locking, joint instability, abdominal or chest pain, or shortness of breath.
  • If pain after the exercise lasts more than an hour, it is too strenuous. Consider decreasing the time or difficulty of the exercise and slowly build up as tolerated.

Note that patients should consult with their physicians prior to starting any exercise programs.

We, as pharmacists, can have a significant impact on the treatment outcome of our patients — let’s not miss the opportunity.

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