Osteoarthritis and exercise

Osteoarthritis (OA) is becoming more common due to our aging society as well as the fact that a significant portion of the Canadian population leads sedentary lifestyles.  Although age contributes to OA formation, it is not the only cause. Instead, OA is a disease process that is initiated and progressed through the interaction of a variety of factors. The plurality of possible contributing factors is the reason why OA does not affect everyone, the severity of the condition is different between individuals, and not all joints are affected equally in individuals with OA (Anderson and Loeser, 2010).

There are many non-modifiable and modifiable factors that contribute to the formation of OA. Some non-modifiable factors include age-related changes in joint anatomy, genetics, anatomical joint abnormalities, and being female. Modifiable factors include weight, lifestyle, and joint injuries.

Although there is currently no cure for OA, there exists a variety of treatments available to effectively alleviate symptoms of OA and improve an individual’s quality of life and function. These treatments are broken down into three main categories: non-pharmacological, pharmacological, and surgery (Badlissi, 2017). One of the most evidence-based non-pharmacological treatment for OA is exercise and education (Badlissi, 2017; Fransen et al., 2015). Since sedentary behaviors and moving with poor biomechanics are common modifiable risk factors of OA, exercise and education is the best strategy to alleviate the condition. Furthermore, unlike many forms of pharmacological and surgical procedures that is associated with many negative side effects, exercise has been shown to have a wide range of benefits, such as increased cardiovascular health and fitness, in addition to its effects in reducing OA-associate disability.

What is the best exercise for Osteoarthritis?

Exercise will minimize the effects of age-related muscle weakness (sarcopenia), osteoporosis, and improve joint stability by enhancing muscular strength around the joints (Badlissi, 2017). All of these will contribute to improving the biomechanics and alignment of the individual, especially during movements. Perhaps more importantly, there is strong evidence showing that exercise should be a staple part of most rehabilitation programs.  Specifically, exercise has been shown to have strong positive effects for chronic low-back pain, sciatica, pregnancy-related pains, repetitive stress injuries, acute strains and sprains, among many others. Despite the many benefits of exercise, patient adherence is a major obstacle. Therefore, patient education is an essential part of the treatment plan. Education not only helps patients understand the nature and causes of OA, it also helps dispel the common negative perceptions and misconceptions of the condition. Part of patient education including reassuring and motivating the patients to adhere to the exercise program. Exercise, like medication, has a dose-response. This means the more exercises you do on a regular basis, the more benefits you will receive from it and when stopped, the benefits will dissipate. In addition to understanding the concept behind why a specific exercise is important for their condition and how to progress it on their own, education plays a huge part in ensuring the patients are doing the exercises properly and safely to protect themselves from injuries. Importantly, education functions to help the individual to understand that exercising and moving is not harmful to the joint itself, as is commonly believed.

How does a physiotherapist treat Osteoarthritis?

As a  physiotherapist, I truly believe in using a holistic approach to the rehabilitation of OA. This including employing my expertise in prescribing specific and individualized exercises combined with patient education. The exercises I prescribe are based on robustly researched and evidence-supported programs of care. Specifically, the GLA:D Canada is an exercise and educational program developed in Denmark for the treatment of hip and knee OA. The program is offered in a class format, where the participants partake in 12 sessions of exercises and three to four sessions of educational lectures. GLA:D Canada has been shown to significantly improve patient self-reported symptoms. Furthermore, the program provides an opportunity for individuals to meet and socialize with others with similar experiences, in addition to providing them a safe space to exercise under professional supervision.  I am excited to be offering the GLA:D Canada program at Physiomobility as a certified GLA:D provider in Toronto.

All-in-all, there are a variety of ways we can treat osteoarthritis and it has been shown in the literature that exercise and education is the best way. Now the only left that’s left is to find what the best treatment for you is, whether it’s working on an individually tailored exercise program with a multidisciplinary team or join a class environment like the GLA:D Canada program.

By: Mihaela Marica,

Registered physiotherapist, GLA:D trained practitioner

Anderson, A. S., & Loeser, R. F. (2010). Why is Osteoarthritis an Age-Related Disease. Best Pract Res Clin Rheumatol. 24(1). 15

Badlissi, F. (2017). BMJ Best Practice: Osteoarthritis. BMJ.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004376. DOI: 1                 0.1002/14651858.CD004376.pub3