Osteoarthritis exercise: why a new review should not stop your routine

Osteoarthritis is a widespread degenerative condition of the joints, causing pain, stiffness and swelling while limiting movement. Although it commonly involves the knees, hips and hands, it may develop in other joints across the body.

If you have received an osteoarthritis diagnosis, your doctor will likely have advised you to exercise. In recent years, this has become routine treatment guidance.

Yet a recent review indicates that exercise may offer less benefit than previously believed.

A closer examination of the research, however, gives several reasons for caution. It is therefore not a reason to abandon your exercise routine.

What the review examined

The researchers carried out an "umbrella review" – a review of systematic reviews, which gather and assess findings from individual studies to address a particular question. Looking at already published systematic reviews offers an even broader view of a research area.

Having searched thousands of studies, the team selected five large systematic reviews, covering 100 individual studies and 8,631 patients. They then included a further 28 recent trials involving another 4,360 patients.

With these data, they assessed how exercise affected osteoarthritis of the knee, hip and hand. They compared exercise with several other approaches, including no treatment, placebo (fake) treatments, education, manual therapy, painkillers, injections and surgery.

Exercise outcomes for osteoarthritis

Against doing nothing or receiving placebos, exercise produced modest pain reductions for hip, knee and hand osteoarthritis: between 6 and 12 points on a 100-point scale.

However, exercise appeared to offer no greater improvement in function than either of those comparisons.

For osteoarthritis of the knee and hip, evidence suggested exercise reduced pain and improved function as effectively as medicines such as ibuprofen and corticosteroids injected into the joint to lessen inflammation. These options also lowered pain by around 5–10%.

The researchers determined that total joint replacement was more effective than exercise for improving pain and function among people with knee and hip osteoarthritis.

What were the limitations?

Firstly, the authors grouped every form of exercise together. In other words, strength training, aerobic exercise, stretching, aquatic exercise and tai chi were treated as though they were identical.

This matters because different forms of exercise do not have equal effects. Earlier reviews have found, for instance, that aerobic exercise may be most effective for improving pain and function in people with knee osteoarthritis, whereas stretching was the least effective.

Likewise, the authors did not take patients' clinical status into account. Evidence indicates that people who begin an intervention with more severe pain and poorer function respond better to exercise than those who have less pain and good function.

Secondly, supervised and unsupervised exercise were considered equivalent in the review.

Yet research indicates that supervised training delivers substantially better results than unsupervised exercise – probably because a trainer can encourage the patient to keep going.

Thirdly, the authors did not consider how long participants exercised for, and most study periods were relatively brief: around 12 weeks.

Maintaining an exercise routine over the long term is likely to deliver better outcomes, creating greater potential for improvement than exercising for only a few weeks.

Consequently, the review's findings may not properly capture the benefits for people with osteoarthritis who maintain regular exercise as an ongoing element of their weekly routine, as is often advised.

Finally, the review did not account for the exercise dose used in the studies. In people with osteoarthritis, gains in pain and function appear to rise with the overall amount of weekly exercise. For example, one review found that the greatest benefits were achieved with around 150 minutes of moderate intensity exercise each week.

Taken together, these limitations indicate that the new review probably understates the benefits of exercise for osteoarthritis.

Reduced pain and improved physical and mental health

Even allowing for the review's limitations, the modest pain reductions it identified may still improve a person's daily life. A 10% reduction in pain could meaningfully improve your capacity to get around, work, socialise and care for others.

The review also showed that exercise can reduce pain to the same degree as non-steroidal anti-inflammatory medications and corticosteroids, but without their costs or side effects.

Exercise may also support heart health, lift your mood, assist with weight management and lower the risk of chronic diseases including cancer and diabetes.

All of these factors may make an enormous difference to your health and wellbeing.

What should you do now?

The findings of this new review should reassure you that any form of exercise can provide some pain relief.

Previous evidence, however, suggests you may gain even greater overall health benefits if you continue exercising consistently.

The most suitable exercise is the one you will actually do. Walking is an excellent option if you enjoy being outdoors, because it can improve every aspect of your health while easing pain.

If pain allows, do not hesitate to challenge yourself occasionally by increasing the intensity until maintaining a conversation becomes difficult.

If you prefer the gym, weight training can also deliver considerable overall health benefits – particularly when you keep it up over the long term.

Hunter Bennett, Lecturer in Exercise Science, Adelaide University and Lewis Ingram, Lecturer in Physiotherapy, Adelaide University

This article is republished from The Conversation under a Creative Commons licence. Read the original article.